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Rogerson SJ, Aitken EH. Malaria in pregnancy: baby steps. Curr Opin Infect Dis 2024; 37:320-326. [PMID: 39018104 DOI: 10.1097/qco.0000000000001037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
PURPOSE OF REVIEW Malaria threatens pregnant women and their babies, particularly in Africa. RECENT FINDINGS This century, the number of women at risk of malaria in pregnancy has decreased globally, apart from in Africa, where it has increased. Low and sub microscopic infections are increasingly documented but remain hard to diagnose with current point-of-care tests, and their contribution to morbidity and transmission are unclear. Artemether-lumefantrine has been endorsed for treatment in first trimester, but many women attend antenatal clinics later in pregnancy, and reaching high-risk young, first-time mothers is particularly difficult. Small-for-gestational-age babies frequently result from malaria, which affects the placenta's development and its functions such as nutrient transport. Resistance to continues to increase to sulphadoxine-pyrimethamine, the mainstay of intermittent preventive treatment in pregnancy. The alternative, dihydroartemisinin-piperaquine controls malaria better, but does not improve pregnancy outcomes, suggesting that sulphadoxine-pyrimethamine may have nonmalarial effects including improving gut function or reducing dangerous inflammation. Understanding of how the malaria parasite uses the VAR2CSA protein to bind to its placental receptor is increasing, informing the search for a vaccine to prevent pregnancy malaria. SUMMARY Progress in several areas increases optimism that improved prevention and control of malaria in pregnancy is possible, but obstacles remain.
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Affiliation(s)
- Stephen J Rogerson
- Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne
- Department of Medicine (RMH), The University of Melbourne, 4 Floor, Clinical Sciences Building, Royal Melbourne Hospital, Royal Parade, Parkville
| | - Elizabeth H Aitken
- Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne
- Department of Microbiology and Immunology, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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Hergott DEB, Guerra CA, García GA, Mba Eyono JN, Donfack OT, Iyanga MM, Nguema Avue RM, Abeso Nsegue CN, Ondo Mifumu TA, Rivas MR, Phiri WP, Murphy SC, Guthrie BL, Smith DL, Balkus JE. Impact of six-month COVID-19 travel moratorium on Plasmodium falciparum prevalence on Bioko Island, Equatorial Guinea. Nat Commun 2024; 15:8285. [PMID: 39333562 PMCID: PMC11436818 DOI: 10.1038/s41467-024-52638-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 09/17/2024] [Indexed: 09/29/2024] Open
Abstract
Importation of malaria infections is a suspected driver of sustained malaria prevalence on areas of Bioko Island, Equatorial Guinea. Quantifying the impact of imported infections is difficult because of the dynamic nature of the disease and complexity of designing a randomized trial. We leverage a six-month travel moratorium in and out of Bioko Island during the initial COVID-19 pandemic response to evaluate the contribution of imported infections to malaria prevalence on Bioko Island. Using a difference in differences design and data from island wide household surveys conducted before (2019) and after (2020) the travel moratorium, we compare the change in prevalence between areas of low historical travel to those with high historical travel. Here, we report that in the absence of a travel moratorium, the prevalence of infection in high travel areas was expected to be 9% higher than observed, highlighting the importance of control measures that target imported infections.
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Affiliation(s)
- Dianna E B Hergott
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
| | - Carlos A Guerra
- MCD Global Health, Bioko Island Malaria Elimination Project, Silver Spring, Maryland, USA
| | - Guillermo A García
- MCD Global Health, Bioko Island Malaria Elimination Project, Silver Spring, Maryland, USA
| | | | - Olivier T Donfack
- MCD Global Health, Bioko Island Malaria Elimination Project, Malabo, Equatorial Guinea
| | - Marcos Mbulito Iyanga
- MCD Global Health, Bioko Island Malaria Elimination Project, Malabo, Equatorial Guinea
| | | | | | | | - Matilde Riloha Rivas
- National Malaria Control Program, Ministry of Health and Social Welfare, Malabo, Equatorial Guinea
| | - Wonder P Phiri
- MCD Global Health, Bioko Island Malaria Elimination Project, Malabo, Equatorial Guinea
| | - Sean C Murphy
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
- Department of Microbiology, University of Washington, Seattle, Washington, USA
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington, USA
| | - Brandon L Guthrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - David L Smith
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- Department of Health Metrics Science, University of Washington, Seattle, Washington, USA
| | - Jennifer E Balkus
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Public Health-Seattle & King County, Seattle, Washington, USA
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Lim S, Johannesson P. An Ontology to Bridge the Clinical Management of Patients and Public Health Responses for Strengthening Infectious Disease Surveillance: Design Science Study. JMIR Form Res 2024; 8:e53711. [PMID: 39325530 PMCID: PMC11467600 DOI: 10.2196/53711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 03/31/2024] [Accepted: 07/01/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Novel surveillance approaches using digital technologies, including the Internet of Things (IoT), have evolved, enhancing traditional infectious disease surveillance systems by enabling real-time detection of outbreaks and reaching a wider population. However, disparate, heterogenous infectious disease surveillance systems often operate in silos due to a lack of interoperability. As a life-changing clinical use case, the COVID-19 pandemic has manifested that a lack of interoperability can severely inhibit public health responses to emerging infectious diseases. Interoperability is thus critical for building a robust ecosystem of infectious disease surveillance and enhancing preparedness for future outbreaks. The primary enabler for semantic interoperability is ontology. OBJECTIVE This study aims to design the IoT-based management of infectious disease ontology (IoT-MIDO) to enhance data sharing and integration of data collected from IoT-driven patient health monitoring, clinical management of individual patients, and disparate heterogeneous infectious disease surveillance. METHODS The ontology modeling approach was chosen for its semantic richness in knowledge representation, flexibility, ease of extensibility, and capability for knowledge inference and reasoning. The IoT-MIDO was developed using the basic formal ontology (BFO) as the top-level ontology. We reused the classes from existing BFO-based ontologies as much as possible to maximize the interoperability with other BFO-based ontologies and databases that rely on them. We formulated the competency questions as requirements for the ontology to achieve the intended goals. RESULTS We designed an ontology to integrate data from heterogeneous sources, including IoT-driven patient monitoring, clinical management of individual patients, and infectious disease surveillance systems. This integration aims to facilitate the collaboration between clinical care and public health domains. We also demonstrate five use cases using the simplified ontological models to show the potential applications of IoT-MIDO: (1) IoT-driven patient monitoring, risk assessment, early warning, and risk management; (2) clinical management of patients with infectious diseases; (3) epidemic risk analysis for timely response at the public health level; (4) infectious disease surveillance; and (5) transforming patient information into surveillance information. CONCLUSIONS The development of the IoT-MIDO was driven by competency questions. Being able to answer all the formulated competency questions, we successfully demonstrated that our ontology has the potential to facilitate data sharing and integration for orchestrating IoT-driven patient health monitoring in the context of an infectious disease epidemic, clinical patient management, infectious disease surveillance, and epidemic risk analysis. The novelty and uniqueness of the ontology lie in building a bridge to link IoT-based individual patient monitoring and early warning based on patient risk assessment to infectious disease epidemic surveillance at the public health level. The ontology can also serve as a starting point to enable potential decision support systems, providing actionable insights to support public health organizations and practitioners in making informed decisions in a timely manner.
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Affiliation(s)
- Sachiko Lim
- Department of Computer and Systems Sciences, Stockholm University, Kista, Sweden
| | - Paul Johannesson
- Department of Computer and Systems Sciences, Stockholm University, Kista, Sweden
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Okiring J, Gonahasa S, Maiteki-Sebuguzi C, Katureebe A, Bagala I, Mutungi P, Kigozi SP, Namuganga JF, Nankabirwa JI, Kamya MR, Donnelly MJ, Churcher TS, Staedke SG, Sherrard-Smith E. LLIN Evaluation in Uganda Project (LLINEUP): modelling the impact of COVID-19-related disruptions on delivery of long-lasting insecticidal nets on malaria indicators in Uganda. Malar J 2024; 23:180. [PMID: 38844987 PMCID: PMC11157881 DOI: 10.1186/s12936-024-05008-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Disruptions in malaria control due to COVID-19 mitigation measures were predicted to increase malaria morbidity and mortality in Africa substantially. In Uganda, long-lasting insecticidal nets (LLINs) are distributed nationwide every 3-4 years, but the 2020-2021 campaign was altered because of COVID-19 restrictions so that the timing of delivery of new nets was different from the original plans made by the National Malaria Control Programme. METHODS A transmission dynamics modelling exercise was conducted to explore how the altered delivery of LLINs in 2020-2021 impacted malaria burden in Uganda. Data were available on the planned LLIN distribution schedule for 2020-2021, and the actual delivery. The transmission model was used to simulate 100 health sub-districts, and parameterized to match understanding of local mosquito bionomics, net use estimates, and seasonal patterns based on data collected in 2017-2019 during a cluster-randomized trial (LLINEUP). Two scenarios were compared; simulated LLIN distributions matching the actual delivery schedule, and a comparable scenario simulating LLIN distributions as originally planned. Model parameters were otherwise matched between simulations. RESULTS Approximately 70% of the study population received LLINs later than scheduled in 2020-2021, although some areas received LLINs earlier than planned. The model indicates that malaria incidence in 2020 was substantially higher in areas that received LLINs late. In some areas, early distribution of LLINs appeared less effective than the original distribution schedule, possibly due to attrition of LLINs prior to transmission peaks, and waning LLIN efficacy after distribution. On average, the model simulations predicted broadly similar overall mean malaria incidence in 2021 and 2022. After accounting for differences in cluster population size and LLIN distribution dates, no substantial increase in malaria burden was detected. CONCLUSIONS The model results suggest that the disruptions in the 2020-2021 LLIN distribution campaign in Uganda did not substantially increase malaria burden in the study areas.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, PO Box 7475, Kampala, Uganda.
- Infectious Diseases Research Collaboration, Kampala, Uganda.
| | | | | | | | - Irene Bagala
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Peter Mutungi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, PO Box 7475, Kampala, Uganda
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses R Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Martin J Donnelly
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Wellcome Sanger Institute, Hinxton, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
| | - Sarah G Staedke
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ellie Sherrard-Smith
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
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Takken W, Charlwood D, Lindsay SW. The behaviour of adult Anopheles gambiae, sub-Saharan Africa's principal malaria vector, and its relevance to malaria control: a review. Malar J 2024; 23:161. [PMID: 38783348 PMCID: PMC11112813 DOI: 10.1186/s12936-024-04982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Mosquitoes of the Anopheles gambiae complex are one of the major vectors of malaria in sub-Saharan Africa. Their ability to transmit this disease of major public health importance is dependent on their abundance, biting behaviour, susceptibility and their ability to survive long enough to transmit malaria parasites. A deeper understanding of this behaviour can be exploited for improving vector surveillance and malaria control. FINDINGS Adult mosquitoes emerge from aquatic habitats at dusk. After a 24 h teneral period, in which the cuticle hardens and the adult matures, they may disperse at random and search upwind for a mate or to feed. Mating generally takes place at dusk in swarms that form over species-specific 'markers'. Well-nourished females may mate before blood-feeding, but the reverse is true for poorly-nourished insects. Females are monogamous and only mate once whilst males, that only feed on nectar, swarm nightly and can potentially mate up to four times. Females are able to locate hosts by following their carbon dioxide and odour gradients. When in close proximity to the host, visual cues, temperature and relative humidity are also used. Most blood-feeding occurs at night, indoors, with mosquitoes entering houses mainly through gaps between the roof and the walls. With the exception of the first feed, females are gonotrophically concordant and a blood meal gives rise to a complete egg batch. Egg development takes two or three days depending on temperature. Gravid females leave their resting sites at dusk. They are attracted by water gradients and volatile chemicals that provide a suitable aquatic habitat in which to lay their eggs. CONCLUSION Whilst traditional interventions, using insecticides, target mosquitoes indoors, additional protection can be achieved using spatial repellents outdoors, attractant traps or house modifications to prevent mosquito entry. Future research on the variability of species-specific behaviour, movement of mosquitoes across the landscape, the importance of light and vision, reproductive barriers to gene flow, male mosquito behaviour and evolutionary changes in mosquito behaviour could lead to an improvement in malaria surveillance and better methods of control reducing the current over-reliance on the indoor application of insecticides.
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Affiliation(s)
- Willem Takken
- Laboratory of Entomology, Wageningen University & Research, PO Box 16, 6700 AA, Wageningen, The Netherlands.
| | - Derek Charlwood
- Global Health and Tropical Medicine, Instituto de Hygiene e Medicina Tropical, Lisbon, Portugal
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Mwanga EP, Siria DJ, Mshani IH, Mwinyi SH, Abbasi S, Jimenez MG, Wynne K, Baldini F, Babayan SA, Okumu FO. Rapid classification of epidemiologically relevant age categories of the malaria vector, Anopheles funestus. Parasit Vectors 2024; 17:143. [PMID: 38500231 PMCID: PMC10949582 DOI: 10.1186/s13071-024-06209-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 02/21/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Accurately determining the age and survival probabilities of adult mosquitoes is crucial for understanding parasite transmission, evaluating the effectiveness of control interventions and assessing disease risk in communities. This study was aimed at demonstrating the rapid identification of epidemiologically relevant age categories of Anopheles funestus, a major Afro-tropical malaria vector, through the innovative combination of infrared spectroscopy and machine learning, instead of the cumbersome practice of dissecting mosquito ovaries to estimate age based on parity status. METHODS Anopheles funestus larvae were collected in rural south-eastern Tanzania and reared in an insectary. Emerging adult females were sorted by age (1-16 days old) and preserved using silica gel. Polymerase chain reaction (PCR) confirmation was conducted using DNA extracted from mosquito legs to verify the presence of An. funestus and to eliminate undesired mosquitoes. Mid-infrared spectra were obtained by scanning the heads and thoraces of the mosquitoes using an attenuated total reflection-Fourier transform infrared (ATR-FT-IR) spectrometer. The spectra (N = 2084) were divided into two epidemiologically relevant age groups: 1-9 days (young, non-infectious) and 10-16 days (old, potentially infectious). The dimensionality of the spectra was reduced using principal component analysis, and then a set of machine learning and multi-layer perceptron (MLP) models were trained using the spectra to predict the mosquito age categories. RESULTS The best-performing model, XGBoost, achieved overall accuracy of 87%, with classification accuracy of 89% for young and 84% for old An. funestus. When the most important spectral features influencing the model performance were selected to train a new model, the overall accuracy increased slightly to 89%. The MLP model, utilizing the significant spectral features, achieved higher classification accuracy of 95% and 94% for the young and old An. funestus, respectively. After dimensionality reduction, the MLP achieved 93% accuracy for both age categories. CONCLUSIONS This study shows how machine learning can quickly classify epidemiologically relevant age groups of An. funestus based on their mid-infrared spectra. Having been previously applied to An. gambiae, An. arabiensis and An. coluzzii, this demonstration on An. funestus underscores the potential of this low-cost, reagent-free technique for widespread use on all the major Afro-tropical malaria vectors. Future research should demonstrate how such machine-derived age classifications in field-collected mosquitoes correlate with malaria in human populations.
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Affiliation(s)
- Emmanuel P Mwanga
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P.O. Box 53, Morogoro, Tanzania.
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK.
| | - Doreen J Siria
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P.O. Box 53, Morogoro, Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Issa H Mshani
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P.O. Box 53, Morogoro, Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Sophia H Mwinyi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P.O. Box 53, Morogoro, Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Said Abbasi
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P.O. Box 53, Morogoro, Tanzania
| | - Mario Gonzalez Jimenez
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
- School of Chemistry, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Klaas Wynne
- School of Chemistry, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Francesco Baldini
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Simon A Babayan
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Fredros O Okumu
- Environmental Health and Ecological Sciences Department, Ifakara Health Institute, P.O. Box 53, Morogoro, Tanzania
- School of Biodiversity, One Health and Veterinary Medicine, University of Glasgow, Glasgow, G12 8QQ, UK
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Life Science and Bioengineering, The Nelson Mandela African Institution of Science and Technology, P. O. Box 447, Arusha, Tanzania
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Asamoah I, Adusei-Poku M, Vandyck-Sey P, Steele-Dadzie A, Kuffour AS, Turkson A, Asante IA, Addo-Osafo K, Mohktar Q, Adu B, Afrane YA, Sagoe KWC. COVID-19 in patients presenting with malaria-like symptoms at a primary healthcare facility in Accra, Ghana. PLoS One 2024; 19:e0298088. [PMID: 38335209 PMCID: PMC10857731 DOI: 10.1371/journal.pone.0298088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Malaria is a common and severe public health problem in Ghana and largely responsible for febrile symptoms presented at health facilities in the country. Other infectious diseases, including COVID-19, may mimic malaria due to their shared non-specific symptoms such as fever and headache thus leading to misdiagnosis. This study therefore investigated COVID-19 among patients presenting with malaria-like symptoms at Korle-Bu Polyclinic, Accra, Ghana. METHODS This study enrolled 300 patients presenting with malaria-like symptoms aged ≥18yrs. After consent was obtained from study patients, two to three millilitres of whole blood, nasopharyngeal and oropharyngeal swab samples, were collected for screening of Plasmodium falciparum using malaria rapid diagnostic test, microscopy and nested PCR, and SARS-CoV-2 using SARS-CoV-2 antigen test and Real-time PCR, respectively. The plasma and whole blood were also used for COVID-19 antibody testing and full blood counts using hematological analyser. SARS-CoV-2 whole genome sequencing was performed using MinIon sequencing. RESULTS The prevalence of malaria by microscopy, RDT and nested PCR were 2.3%, 2.3% and 2.7% respectively. The detection of SARS-CoV-2 by COVID-19 Rapid Antigen Test and Real-time PCR were 8.7% and 20% respectively. The Delta variant was reported in 23 of 25 SARS-CoV-2 positives with CT values below 30. Headache was the most common symptom presented by study participants (95%). Comorbidities reported were hypertension, asthma and diabetes. One hundred and thirteen (37.8%) of the study participants had prior exposure to SARS CoV-2 and (34/51) 66.7% of Astrazeneca vaccinated patients had no IgG antibody. CONCLUSION It may be difficult to use clinical characteristics to distinguish between patients with COVID-19 having malaria-like symptoms. Detection of IgM using RDTs may be useful in predicting CT values for SARS-CoV-2 real-time PCR and therefore transmission.
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Affiliation(s)
- Issabella Asamoah
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Mildred Adusei-Poku
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Priscilla Vandyck-Sey
- Korle Bu Polyclinic Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Allen Steele-Dadzie
- Korle Bu Polyclinic Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Atta Senior Kuffour
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Albert Turkson
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Ivy Asantewaa Asante
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Kantanka Addo-Osafo
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Quaneeta Mohktar
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Yaw A. Afrane
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Kwamena W. C. Sagoe
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
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Malm KL, Peprah NY, Mohammed W, Adomako BY, Oppong S, Boateng P, Adu GA, Dadzie D, Adza G, Forson I, Frimpong J. A retrospective analysis of malaria deaths in the pre- and intra- COVID 19 pandemic era, Ghana, 2016-2021. PLoS One 2024; 19:e0286212. [PMID: 38319929 PMCID: PMC10846731 DOI: 10.1371/journal.pone.0286212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/10/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Global efforts over the years have resulted in a 27% reduction in malaria incidence and an estimated 51% reduction in malaria mortality since 2000. Meanwhile, COVID-19 pandemic disrupted provision and utilization of malaria services, leading to a surge in malaria incidence and mortality. Globally, 627000 malaria deaths were recorded in 2020, representing about 69000 more deaths compared to 2019. Also, 14 million more cases of malaria were recorded in 2020 compared to 2019. This study sought to determine whether excess malaria deaths were recorded in Ghana during the COVID-19 pandemic era. METHODS This was a descriptive study on routine malaria mortality data in Ghana for the period 2016 to 2021. Data was retrieved from the District Health Information Management System using a data extraction guide. Excess mortality was defined as occurrence of malaria deaths more than expected value for the period 2020 and 2021. The expected number of mortalities for 2020 and 2021 were determined using 2016 to 2019 average. Excess mortality (P-score) was estimated using the formula: [(reported mortalities-expected mortalities)/expected mortalities X 100%]. Data were summarized and processed in Microsoft excel version 16.0. Malaria mortality in Ghana and its regions was described using tables and line graphs. RESULTS An average of 535 malaria deaths per year were recorded nationwide from 2016 to 2020. About 50% (1603/3207) of deaths occurred in children aged less than five years. The p-scores for the country were -53% and -58% for 2020 and 2021 respectively. No region recorded excess all-age malaria mortality in 2020, rather significant reduction. Stratified by age, Greater Accra region reported 90% higher than expected deaths among persons aged five years and above in 2020 (p-score = 90%, 95% CI: 21-159). All regions reported reduction in under-five mortality in 2020. No significant excess malaria mortalities were reported among the regions in 2021. CONCLUSION Although negative p-scores suggested a decline in malaria mortalities nationwide, some regions recorded excess deaths during the COVID-19 pandemic era. There is a need to integrate COVID-19 control activities with malaria control and prevention efforts to mitigate the impact of COVID-19 on malaria case management and mortality.
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Affiliation(s)
- Keziah L. Malm
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Nana Yaw Peprah
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Wahjib Mohammed
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Boakye-Yiadom Adomako
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Samuel Oppong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Paul Boateng
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - George Asumah Adu
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Dora Dadzie
- Department of Public Health, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Grace Adza
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - Ivy Forson
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
| | - James Frimpong
- National Malaria Control Programme, Public Health Division, Ghana Health Service, Accra, Ghana
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Hoi AG, N’Tcha LK, Duguay C, Accrombessi M, Akinro B, Feng C, Labonté R, Protopopoff N, Akogbeto M, Kulkarni MA. Health systems impacts of the COVID-19 pandemic on malaria control program implementation and malaria burden in Benin: A mixed-method qualitative and mathematical modelling and study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002197. [PMID: 38306342 PMCID: PMC10836704 DOI: 10.1371/journal.pgph.0002197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
The COVID-19 pandemic has sent ripple effects across health systems and impacted the burden of many other diseases, such as malaria in sub-Saharan Africa. This study takes a mixed method approach to assess the impact of COVID-19 on malaria control programs in three rural communes in Benin. We conducted individual semi-structured interviews with key informants who play important roles in malaria control in Benin at three levels of the health system-national, health zone, and commune. Using a purposive sampling technique, informants were interviewed regarding their roles in malaria control, the impact of the pandemic on their activities, and the mitigation strategies adopted. Relevant themes were identified by content analysis. We then formulated an agent-based model of malaria epidemiology to assess the impacts of treatment disruption on malaria burden. The key informant interviews revealed that essential aspects of malaria control were upheld in Benin due to the close collaboration of public health practitioners and health care providers at all levels of the health system. There were some disruptions to case management services for malaria at the start of the pandemic due to the public avoiding health centers and a brief shortage of malaria treatment that may not be entirely attributable to the pandemic. Results from the agent-based model suggest that duration, severity, and timing of treatment disruption can impact malaria burden in a synergistic manner, though the effects are small given the relatively mild disruptions observed. This study highlights the importance of top-down leadership in health emergencies, as well as the critical role of community health workers in preventing negative health outcomes for their communities. We also showcased the integration of qualitative research and mathematical models-an underappreciated form of mixed methods research that offer immense value in the continued evaluation of rapidly evolving health emergencies.
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Affiliation(s)
- Amber Gigi Hoi
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ludovic K. N’Tcha
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
- Laboratory of Applied Anthropology and Education for Sustainable Development, University of Abomey-Calavi, Abomey-Calavi, Benin
| | - Claudia Duguay
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Manfred Accrombessi
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Bruno Akinro
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
| | - Cindy Feng
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada
| | - Ronald Labonté
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | - Martin Akogbeto
- Centre de Recherche Entomologique de Cotonou, Cotonou, Benin
| | - Manisha A. Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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10
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Sun Z, Bai R, Bai Z. The application of simulation methods during the COVID-19 pandemic: A scoping review. J Biomed Inform 2023; 148:104543. [PMID: 37956729 DOI: 10.1016/j.jbi.2023.104543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/19/2023] [Accepted: 11/09/2023] [Indexed: 11/15/2023]
Abstract
With the outbreak of COVID-19 pandemic, simulation modelling approaches have become effective tools to simulate the potential effects of different intervention measures and predict the dynamic COVID-19 trends. In this scoping review, Studies published between February 2020 and May 2022 that investigated the spread of COVID-19 using four common simulation modeling methods were systematically reported and summarized. Publication trend, characteristics, software, and code availability of included articles were analyzed. Among the included 340 studies, most articles used agent-based model (ABM; n = 258; 75.9 %), followed by the models of system dynamics (n = 42; 12.4 %), discrete event simulation (n = 25; 7.4 %), and hybrid simulation (n = 15; 4.4 %). Furthermore, our review emphasized the purposes and sample time period of included articles. We classified the purpose of the 340 included studies into five categories, most studies mainly analyzed the spread of COVID-19 under policy interventions. For the sample time period analysis, most included studies analyzed the COVID-19 spread in the second wave. Our findings play a crucial role for policymakers to make evidence-based decisions in preventing the spread of COVID-19 pandemic and help in providing scientific decision-makings resilient to similar events and infectious diseases in the future.
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Affiliation(s)
- Zhuanlan Sun
- High-Quality Development Evaluation Institute, Nanjing University of Posts and Telecommunications, Nanjing 210003, China
| | - Ruhai Bai
- Evidence-Based Research Center of Social Science and Health, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China
| | - Zhenggang Bai
- Evidence-Based Research Center of Social Science and Health, School of Public Affairs, Nanjing University of Science and Technology, Nanjing, China.
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11
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Aguma HB, Rukaari M, Nakamatte R, Achii P, Miti JT, Muhumuza S, Nabukenya M, Opigo J, Lukwago M. Mass distribution campaign of long-lasting insecticidal nets (LLINs) during the COVID-19 pandemic in Uganda: lessons learned. Malar J 2023; 22:310. [PMID: 37845711 PMCID: PMC10577996 DOI: 10.1186/s12936-023-04753-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Uganda implemented its third mass campaign to distribute long-lasting insecticidal nets (LLINs) in 2020 during the COVID-19 pandemic. This context necessitated modification of implementation guidelines. The mass campaign's objective was to ensure that at least 85% of the targeted population had access to LLINs. METHODS Revised implementation guidelines were followed while conducting the LLIN distribution campaign. Lessons learned were captured from documented activities and reports. RESULTS A total of 27,789,044 mosquito nets were distributed in 11,287,392 households, with an average of 5.1 persons per household. Household coverage of the LLIN distribution was 94.1%. The 2020/2021 campaign design was modified to follow COVID-19 Standard Operating Procedures (SOPs). These included using Personal Protective Equipment (PPE), e-platforms for training and briefing meetings, electronic data management systems and door-to-door household registration and distribution of LLINs. CONCLUSIONS Campaign modifications due to the COVID-19 pandemic were effective in implementing mass distribution of LLINs despite the disruptions and restrictions. The campaign's net coverage far exceeded its objective. Electronic data management was critical in monitoring and reporting distribution activities.
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Affiliation(s)
- Herbert Bush Aguma
- National Malaria Control Division, Ministry of Health, Kampala, Uganda.
- Department of Pharmacy, Makerere University, Kampala, Uganda.
| | - Medard Rukaari
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Rukia Nakamatte
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Pamela Achii
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Joel Tutu Miti
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Solomon Muhumuza
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Mariam Nabukenya
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Jimmy Opigo
- National Malaria Control Division, Ministry of Health, Kampala, Uganda
| | - Martin Lukwago
- Department of Planning, Finance & Policy, Ministry of Health, Kampala, Uganda
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12
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Veettil SK, Schwerer L, Kategeaw W, Toth D, Samore MH, Hutubessy R, Chaiyakunapruk N. Scoping review of modelling studies assessing the impact of disruptions to essential health services during COVID-19. BMJ Open 2023; 13:e071799. [PMID: 37751952 PMCID: PMC10533712 DOI: 10.1136/bmjopen-2023-071799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Studies assessing the indirect impact of COVID-19 using mathematical models have increased in recent years. This scoping review aims to identify modelling studies assessing the potential impact of disruptions to essential health services caused by COVID-19 and to summarise the characteristics of disruption and the models used to assess the disruptions. METHODS Eligible studies were included if they used any models to assess the impact of COVID-19 disruptions on any health services. Articles published from January 2020 to December 2022 were identified from PubMed, Embase and CINAHL, using detailed searches with key concepts including COVID-19, modelling and healthcare disruptions. Two reviewers independently extracted the data in four domains. A descriptive analysis of the included studies was performed under the format of a narrative report. RESULTS This scoping review has identified a total of 52 modelling studies that employed several models (n=116) to assess the potential impact of disruptions to essential health services. The majority of the models were simulation models (n=86; 74.1%). Studies covered a wide range of health conditions from infectious diseases to non-communicable diseases. COVID-19 has been reported to disrupt supply of health services, demand for health services and social change affecting factors that influence health. The most common outcomes reported in the studies were clinical outcomes such as mortality and morbidity. Twenty-five studies modelled various mitigation strategies; maintaining critical services by ensuring resources and access to services are found to be a priority for reducing the overall impact. CONCLUSION A number of models were used to assess the potential impact of disruptions to essential health services on various outcomes. There is a need for collaboration among stakeholders to enhance the usefulness of any modelling. Future studies should consider disparity issues for more comprehensive findings that could ultimately facilitate policy decision-making to maximise benefits to all.
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Affiliation(s)
- Sajesh K Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- School of Medicine, Taylor's University, 47500 Subang Jaya, Selangor, Malaysia
| | - Luke Schwerer
- USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- School of Pharmacy, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Warittakorn Kategeaw
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Damon Toth
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Matthew H Samore
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals (IVB) Department, World Health Organization, Geneva, Switzerland
| | - Nathorn Chaiyakunapruk
- Department of Pharmacotherapy, College of Pharmacy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
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13
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Mhango P, Malata MP, Chipeta E, Sixpence A, Taylor TE, Wilson ML, Cohee LM, Mangani C, Mathanga DP. Barriers to accessing malaria treatment amongst school-age children in rural Malawi. Malar J 2023; 22:258. [PMID: 37674177 PMCID: PMC10481490 DOI: 10.1186/s12936-023-04695-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Over the last two decades, many countries have moved from malaria control toward malaria elimination. However, some sub-Saharan African countries, like Malawi, have recently seen a reversal in malaria control progress with reported increases in confirmed malaria cases. This may be the result of inadequate access to effective malaria control interventions by key population groups that perpetuate transmission. This study aimed to assess the barriers to accessing malaria treatment among school-aged children (SAC) in Malawi. METHODS A qualitative study was conducted between September and October 2020, where data were gathered in rural Malawi using free-listing interviews, key-informant interviews, semi-structured interviews and focus group discussions. Purposively sampled participants included SAC, parents of SAC, health workers and key stakeholders at community and district levels. Interviews were digitally recorded and transcribed verbatim. Data were organized using NVivo 12 software and analysed using the thematic method. RESULTS The study recruited 252 participants, with 156 being SAC, equally divided between boys and girls. Health system barriers to malaria treatment included long waiting hours and queues at clinics, frequent stock-outs of medical supplies, and travel time to the facility. Provider barriers included negative attitude and limited service hours. Individual and cultural barriers included fear of malaria tests and beliefs associating witchcraft as the best treatment for malaria. In addition, COVID-19-related barriers included the inability to follow preventive measures, a shift in focus from malaria to COVID-19, and fear of contracting COVID-19 and/or being tested for COVID-19 at the facility. CONCLUSIONS This study shows most of the barriers to accessing malaria treatment among SAC are similar to those experienced by other population groups. Furthermore, COVID-19 adversely affected SAC's access to treatment. Interventions that support SAC access to prompt diagnosis and treatment are urgently needed to improve the effective control of malaria.
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Affiliation(s)
- Patani Mhango
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Monica Patricia Malata
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Effie Chipeta
- Centre for Reproductive Health (CRH), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Terrie E Taylor
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Mark L Wilson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Lauren M Cohee
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Don P Mathanga
- School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
- Malaria Alert Centre (MAC), Kamuzu University of Health Sciences (KUHeS), Private Bag 360, Chichiri, Blantyre 3, Malawi
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14
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Wichmann B, Moreira Wichmann R. Big data evidence of the impact of COVID-19 hospitalizations on mortality rates of non-COVID-19 critically ill patients. Sci Rep 2023; 13:13613. [PMID: 37604881 PMCID: PMC10442321 DOI: 10.1038/s41598-023-40727-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023] Open
Abstract
The COVID-19 virus caused a global pandemic leading to a swift policy response. While this response was designed to prevent the spread of the virus and support those with COVID-19, there is growing evidence regarding measurable impacts on non-COVID-19 patients. The paper uses a large dataset from administrative records of the Brazilian public health system (SUS) to estimate pandemic spillover effects in critically ill health care delivery, i.e. the additional mortality risk that COVID-19 ICU hospitalizations generate on non-COVID-19 patients receiving intensive care. The data contain the universe of ICU hospitalizations in SUS from February 26, 2020 to December 31, 2021. Spillover estimates are obtained from high-dimensional fixed effects regression models that control for a number of unobservable confounders. Our findings indicate that, on average, the pandemic increased the mortality risk of non-COVID-19 ICU patients by 1.296 percentage points, 95% CI 1.145-1.448. The spillover mortality risk is larger for non-COVID patients receiving intensive care due to diseases of the respiratory system, diseases of the skin and subcutaneous tissue, and infectious and parasitic diseases. As of July 2023, the WHO reports more than 6.9 million global deaths due to COVID-19 infection. However, our estimates of spillover effects suggest that the pandemic's total death toll is much higher.
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Affiliation(s)
- Bruno Wichmann
- Department of Resource Economics & Environmental Sociology, College of Natural and Applied Sciences, University of Alberta, 503 General Services Building, Edmonton, AB, T6G-2H1, Canada.
| | - Roberta Moreira Wichmann
- World Bank, Brasília, Brazil
- Brazilian Institute of Education, Development and Research-IDP, Brasília, Brazil
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15
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Gómez-Pérez GP, de Groot R, Abajobir AA, Wainaina CW, Rinke de Wit TF, Sidze E, Pradhan M, Janssens W. Reduced incidence of respiratory, gastrointestinal and malaria infections among children during the COVID-19 pandemic in Western Kenya: An analysis of facility-based and weekly diaries data. J Glob Health 2023; 13:06024. [PMID: 37448326 DOI: 10.7189/jogh.13.06024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
Background Epidemics can cause significant disruptions of essential health care services. This was evident in West-Africa during the 2014-2016 Ebola outbreak, raising concerns that COVID-19 would have similar devastating consequences for the continent. Indeed, official facility-based records show a reduction in health care visits after the onset of COVID-19 in Kenya. Our question is whether this observed reduction was caused by lower access to health care or by reduced incidence of communicable diseases resulting from reduced mobility and social contacts. Methods We analysed monthly facility-based data from 2018 to 2020, and weekly health diaries data digitally collected by trained fieldworkers between February and November 2020 from 342 households, including 1974 individuals, in Kisumu and Kakamega Counties, Kenya. Diaries data was collected as part of an ongoing longitudinal study of a digital health insurance scheme (Kakamega), and universal health coverage implementation (Kisumu). We assessed the weekly incidence of self-reported medical symptoms, formal and informal health-seeking behaviour, and foregone care in the diaries and compared it with facility-based records. Linear probability regressions with household fixed-effects were performed to compare the weekly incidence of health outcomes before and after COVID-19. Results Facility-based data showed a decrease in health care utilization for respiratory infections, enteric illnesses, and malaria, after start of COVID-19 measures in Kenya in March 2020. The weekly diaries confirmed this decrease in respiratory and enteric symptoms, and malaria / fever, mainly in the paediatric population. In terms of health care seeking behaviour, our diaries data find a temporary shift in consultations from health care centres to pharmacists / chemists / medicine vendors for a few weeks during the pandemic, but no increase in foregone care. According to the diaries, for adults the incidence of communicable diseases/symptoms rebounded after COVID-19 mobility restrictions were lifted, while for children the effects persisted. Conclusions COVID-19-related containment measures in Western Kenya were accompanied by a decline in respiratory infections, enteric illnesses, and malaria / fever mainly in children. Data from a population-based survey and facility-based records aligned regarding this finding despite the temporary shift to non-facility-based consultations and confirmed that the drop in utilization of health care services was not due to decreased accessibility, but rather to a lower incidence of these infections.
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Affiliation(s)
- Gloria P Gómez-Pérez
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- PharmAccess Foundation, Amsterdam, the Netherlands
| | - Richard de Groot
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
| | | | - Caroline W Wainaina
- African Population and Health Research Centre, Nairobi, Kenya
- Universiteit Utrecht, Amsterdam, the Netherlands
| | - Tobias F Rinke de Wit
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- PharmAccess Foundation, Amsterdam, the Netherlands
| | - Estelle Sidze
- African Population and Health Research Centre, Nairobi, Kenya
| | - Menno Pradhan
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- Vrije Universiteit, Amsterdam, the Netherlands
- Universiteit van Amsterdam, the Netherlands
| | - Wendy Janssens
- Amsterdam Institute of Global Health and Development, Amsterdam, the Netherlands
- Vrije Universiteit, Amsterdam, the Netherlands
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16
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Nana RRD, Hawadak J, Foko LPK, Kumar A, Chaudhry S, Arya A, Singh V. Intermittent preventive treatment with Sulfadoxine pyrimethamine for malaria: a global overview and challenges affecting optimal drug uptake in pregnant women. Pathog Glob Health 2023; 117:462-475. [PMID: 36177658 PMCID: PMC10337642 DOI: 10.1080/20477724.2022.2128563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Malaria in Pregnancy (MiP) leading to morbidity and mortality is a major public health problem that poses significant risk to pregnant women and their fetus. To cope with this alarming situation, administration of Sulfadoxine-pyrimethamine (SP) drugs to pregnant women as an intermittent preventive treatment (IPT) from 16 weeks of gestation is recommended by the World Health Organization (WHO) guidelines. We conducted a comprehensive search of published articles related to MiP in last 10 years with predefined keywords or their synonyms. The mapping of malaria in pregnant women showed a prevalence rate up to 35% in many countries. Although IPTp-SP has been implemented in endemic regions since several years but the IPTp-SP coverage percentage vary from country to country and continue to remain below the target of 80%. Major reasons for low IPTp-SP involve gestational age at first prenatal visit, level of education, place of residence, knowledge of IPTp-SP benefits, and use of antenatal services. Several challenges including the emergence of septuple and octuple SP-resistant parasites is reported from many countries which make the prophylactic use of IPTp-SP currently debatable. This narrative review addresses the barriers for optimal use of IPTp-SP and discusses alternative approaches to increase the use and effectiveness of SP intervention for preventing MiP. The COVID pandemic has drastically affected the public health disrupting the management of diseases worldwide. In view of this, a brief summary of COVID impact on MiP situation is also included.
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Affiliation(s)
- Rodrigue Roman Dongang Nana
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
- Parasitology laboratory, Institute of Medical Research and Medicinal Plants Studies (IMPM), Yaoundé, Cameroon
| | - Joseph Hawadak
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Loick Pradel Kojom Foko
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Amit Kumar
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Shewta Chaudhry
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Aditi Arya
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
| | - Vineeta Singh
- Parasite Host Biology group, ICMR-National Institute of Malaria Research (NIMR), New Delhi, India
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Kessel B, Heinsohn T, Ott JJ, Wolff J, Hassenstein MJ, Lange B. Impact of COVID-19 pandemic and anti-pandemic measures on tuberculosis, viral hepatitis, HIV/AIDS and malaria-A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001018. [PMID: 37126484 PMCID: PMC10150989 DOI: 10.1371/journal.pgph.0001018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/27/2023] [Indexed: 05/02/2023]
Abstract
COVID-19 pandemic puts an enormous strain on health care systems worldwide and may have a detrimental effect on prevention, treatment and outcomes of tuberculosis (TB), viral hepatitis, HIV/AIDS and malaria, whose ending is part of the United Nations 2030 Agenda for Sustainable Development. We conducted a systematic review of scientific and grey literature in order to collect wide-ranging evidence with emphasis on quantification of the projected and actual indirect impacts of COVID-19 on the four infectious diseases with a global focus. We followed PRISMA guidelines and the protocol registered for malaria (CRD42021234974). We searched PubMed, Scopus, preView (last search: January 13, 2021) and websites of main (medical) societies and leading NGOs related to each of the four considered infectious diseases. From modelling studies, we identified the most impactful disruptions; from surveys and other quantitative studies (based e.g. on surveillance or program data), we assessed the actual size of the disruptions. The identified modelling studies warned about under-diagnosis (TB), anti-retroviral therapy interruption/decrease in viral load suppression (HIV), disruptions of insecticide-treated nets (ITN) distribution and access to effective treatment (malaria), and treatment delays and vaccination interruptions (viral hepatitis). The reported disruptions were very heterogeneous both between and within countries. If observed at several points in time, the initial drops (partly dramatic, e.g. TB notifications/cases, or HIV testing volumes decreased up to -80%) were followed by a gradual recovery. However, the often-missing assessment of the changes against the usual pre-pandemic fluctuations hampered the interpretation of less severe ones. Given the recurring waves of the pandemic and the unknown mid- to long-term effects of adaptation and normalisation, the real consequences for the fight against leading infectious diseases will only manifest over the coming years.
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Affiliation(s)
- Barbora Kessel
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Torben Heinsohn
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Jördis J. Ott
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
- Hannover Medical School (MHH), Hannover, Germany
| | - Jutta Wolff
- Hannover Medical School (MHH), Hannover, Germany
| | - Max J. Hassenstein
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
- PhD Programme “Epidemiology”, Braunschweig, Hannover, Germany
| | - Berit Lange
- Department of Epidemiology, Helmholtz Center for Infection Research, Braunschweig, Germany
- German Center for Infection research (DZIF), Partner Site Hannover-Braunschweig, Braunschweig, Germany
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18
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Ibrahim OR, Alao MA, Suleiman BM, Mokuolu OA. Outcomes of childhood severe malaria: a comparative of study pre-COVID-19 and COVID-19 periods. BMC Pediatr 2023; 23:177. [PMID: 37061668 PMCID: PMC10105138 DOI: 10.1186/s12887-023-03985-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 04/02/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND The collateral damages from measures adopted to mitigate the coronavirus disease 2019 (COVID-19) pandemic have been projected to negatively impact malaria in sub-Saharan Africa. Herein, we compare the prevalence and outcomes of childhood severe malaria during the pre-COVID-19 and COVID-19 periods at a tertiary health facility in Nigeria. METHODS This was a retrospective review of cases of severe malaria admitted from 1st January to 31st December 2019 (pre-COVID-19 period) and 1st January to 31st December 2020 (COVID-19 period). We extracted relevant information, including demographics, the duration of symptoms before presentation, forms of severe malaria, and outcomes of hospitalization (discharged or death). RESULTS In the pre-COVID-19 period, there were a total of 2312 admissions to the EPU and 1685 in the COVID-19 period, representing a decline of 27%. In contrast, there were 263 and 292 severe malaria admissions in the pre-COVID-19 and COVID-19 periods, respectively, representing an 11% increase in the absolute number of cases. The prevalence rates were 11.4% in the pre-COVID-19 period and 17.3% in the COVID-19 period, representing an increase of 52% in the percentage differences. The mortality rate in the COVID-19 period was higher than the pre-COVID-19 period ([10.3%; 30/292 vs. 2.3%; 6/263], p 0.001). The death rate increased by 350% during the COVID-19 period. The odds ratio (OR) of a child dying from severe malaria in the COVID-19 era was 4.9 [95% confidence interval (CI): 2.008 to 11.982]. In the COVID-19 era, presentation at a health facility was also delayed (p = 0.029), as were the odds of multiple features of severe malaria manifestations (OR-1.9, 95% CI, 1.107 to 3.269; p = 0.020). CONCLUSION This study shows that the prevalence of severe childhood malaria increased by as much as 11.0%, with a disproportionate increase in mortality compared to the pre-pandemic level. Most children with severe malaria presented late with multiple features of severe malaria, probably contributing to the poor hospitalization outcomes (death) observed in this study.
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Affiliation(s)
- Olayinka Rasheed Ibrahim
- Department of Pediatrics, Federal Teaching Hospital, Katsina, Katsina State, Nigeria
- Department of Pediatrics, University of Ilorin Teaching Hospital, & University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Michael Abel Alao
- Department of Pediatrics, University College Hospital, & University of Ibadan, Ibadan, Oyo state, Nigeria
| | | | - Olugbenga Ayodeji Mokuolu
- Department of Pediatrics, University of Ilorin Teaching Hospital, & University of Ilorin, Ilorin, Kwara State, Nigeria.
- Department of Pediatrics and Child Health, University of Ilorin, Ilorin, Kwara State, Nigeria.
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19
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Maniga JN, Samuel M, John O, Rael M, Muchiri JN, Bwogo P, Martin O, Sankarapandian V, Wilberforce M, Albert O, Onkoba SK, Adebayo IA, Adeyemo RO, Akinola SA. Novel Plasmodium falciparum k13 gene polymorphisms from Kisii County, Kenya during an era of artemisinin-based combination therapy deployment. Malar J 2023; 22:87. [PMID: 36894982 PMCID: PMC9996564 DOI: 10.1186/s12936-023-04517-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Currently, chemotherapy stands out as the major malaria intervention strategy, however, anti-malarial resistance may hamper global elimination programs. Artemisinin-based combination therapy (ACT) stands as the drug of choice for the treatment of Plasmodium falciparum malaria. Plasmodium falciparum kelch13 gene mutations are associated with artemisinin resistance. Thus, this study was aimed at evaluating the circulation of P. falciparum k13 gene polymorphisms from Kisii County, Kenya during an era of ACT deployment. METHODS Participants suspected to have malaria were recruited. Plasmodium falciparum was confirmed using the microscopy method. Malaria-positive patients were treated with artemether-lumefantrine (AL). Blood from participants who tested positive for parasites after day 3 was kept on filter papers. DNA was extracted using chelex-suspension method. A nested polymerase chain reaction (PCR) was conducted and the second-round products were sequenced using the Sanger method. Sequenced products were analysed using DNAsp 5.10.01 software and then blasted on the NCBI for k13 propeller gene sequence identity using the Basic Local Alignment Search Tool (BLAST). To assess the selection pressure in P. falciparum parasite population, Tajima' D statistic and Fu & Li's D test in DnaSP software 5.10.01 was used. RESULTS Out of 275 enrolled participants, 231 completed the follow-up schedule. 13 (5.6%) had parasites on day 28 hence characterized for recrudescence. Out of the 13 samples suspected of recrudescence, 5 (38%) samples were positively amplified as P. falciparum, with polymorphisms in the k13-propeller gene detected. Polymorphisms detected in this study includes R539T, N458T, R561H, N431S and A671V, respectively. The sequences have been deposited in NCBI with bio-project number PRJNA885380 and accession numbers SAMN31087434, SAMN31087433, SAMN31087432, SAMN31087431 and SAMN31087430 respectively. CONCLUSIONS WHO validated polymorphisms in the k13-propeller gene previously reported to be associated with ACT resistance were not detected in the P. falciparum isolates from Kisii County, Kenya. However, some previously reported un-validated k13 resistant single nucleotide polymorphisms were reported in this study but with limited occurrences. The study has also reported new SNPs. More studies need to be carried out in the entire country to understand the association of reported mutations if any, with ACT resistance.
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Affiliation(s)
- Josephat Nyabayo Maniga
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda.
| | | | - Odda John
- School of Pharmacy, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Pharmacology and Therapeutics, Makerere University, Kampala, Uganda.,Department of Pharmacology and Toxicology, School of Medicine, King Caesor University, Kampala, Uganda
| | - Masai Rael
- Department of Biological Sciences, Kisii University, Kisii, Kenya
| | | | - Pacifica Bwogo
- Department of Biological Sciences, Kisii University, Kisii, Kenya
| | - Odoki Martin
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Medical Microbiology and Immunology, School of Medicine, King Ceasor University, Kampala, Uganda.,Department of Applied Sciences, School of Sciences, Nkumba University, Entebbe, Uganda
| | - Vidya Sankarapandian
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
| | - Mfitundinda Wilberforce
- School of Pharmacy, Kampala International University Western Campus, Bushenyi, Uganda.,Department of Pharmacology and Toxicology, School of Medicine, King Caesor University, Kampala, Uganda
| | - Ochweri Albert
- School of Pharmacy, Kampala International University Western Campus, Bushenyi, Uganda
| | - Sarah Kemuma Onkoba
- Department of Medical Microbiology and Immunology, Kampala International University Western Campus, Bushenyi, Uganda
| | - Ismail Abiola Adebayo
- Department of Medical Biochemistry, Molecular Biology and Genetics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Rasheed Omotayo Adeyemo
- Department of Medical Microbiology and Parasitology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
| | - Saheed Adekunle Akinola
- Department of Medical Microbiology and Parasitology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda
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20
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Heuschen AK, Abdul-Mumin A, Abubakari A, Agbozo F, Lu G, Jahn A, Müller O. Effects of the COVID-19 pandemic on general health and malaria control in Ghana: a qualitative study with mothers and health care professionals. Malar J 2023; 22:78. [PMID: 36872343 PMCID: PMC9986038 DOI: 10.1186/s12936-023-04513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/24/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND COVID-19 has severely impacted health systems and the management of non-COVID-19 diseases, including malaria, globally. The pandemic has hit sub-Saharan Africa less than expected; even considering large underreporting, the direct COVID-19 burden was minor compared to the Global North. However, the indirect effects of the pandemic, e.g. on socio-economic inequality and health care systems, may have been more disruptive. Following a quantitative analysis from northern Ghana, which showed significant reductions in overall outpatient department visits and malaria cases during the first year of COVID-19, this qualitative study aims to provide further explanations to those quantitative findings. METHODS In the Northern Region of Ghana, 72 participants, consisting of 18 health care professionals (HCPs) and 54 mothers of children under the age of five, were recruited in urban and rural districts. Data were collected using focus group discussions with mothers and through key informant interviews with HCPs. RESULTS Three main themes occurred. The first theme-general effects of the pandemic-includes impacts on finances, food security, health service provision as well as education and hygiene. Many women lost their jobs, which increased their dependance on males, children had to drop out of school, and families had to cope with food shortages and were considering migration. HCPs had problems reaching the communities, suffered stigmatisation and were often barely protected against the virus. The second theme-effects on health-seeking-includes fear of infection, lack of COVID-19 testing capacities, and reduced access to clinics and treatment. The third theme-effects on malaria-includes disruptions of malaria preventive measures. Clinical discrimination between malaria and COVID-19 symptoms was difficult and HCPs observed increases in severe malaria cases in health facilities due to late reporting. CONCLUSION The COVID-19 pandemic has had large collateral impacts on mothers, children and HCPs. In addition to overall negative effects on families and communities, access to and quality of health services was severely impaired, including serious implications on malaria. This crisis has highlighted weaknesses of health care systems globally, including the malaria situation; a holistic analysis of the direct and indirect effects of this pandemic and an adapted strengthening of health care systems is essential to be prepared for the future.
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Affiliation(s)
- Anna-Katharina Heuschen
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany.
| | - Alhassan Abdul-Mumin
- School of Medicine, Department of Paediatrics and Child Health, University for Development Studies, Tamale, Ghana
- Tamale Teaching Hospital, Tamale, Ghana
| | - Abdulai Abubakari
- School of Public Health, Department of Global Health, University for Development Studies, Tamale, Ghana
| | - Faith Agbozo
- Fred Binka School of Public Health, Department of Family and Community Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Guangyu Lu
- School of Public Health, Medical School, Yangzhou University, Yangzhou, China
| | - Albrecht Jahn
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
| | - Olaf Müller
- Institute for Global Health, University Hospital Heidelberg, Ruprecht-Karls-University, Heidelberg, Germany
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21
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Mazaherifar S, Solhjoo K, Rasti S, Heidarnejadi SM, Abdoli A. Patterns of cutaneous leishmaniasis during the COVID-19 pandemic in four endemic regions of Iran. Trans R Soc Trop Med Hyg 2023; 117:38-44. [PMID: 36068660 DOI: 10.1093/trstmh/trac081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/16/2022] [Accepted: 08/04/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Both zoonotic cutaneous leishmaniasis (ZCL) and anthroponotic cutaneous leishmaniasis are endemic in different regions of Iran. It is important to know the type of cutaneous leishmaniasis (CL) for prevention strategies. On the other hand, Iran is one of the countries that was severely affected by the coronavirus 2019 (COVID-19) pandemic. However, little is known about the causative agents of CL during the COVID-19 pandemic in Iran. METHODS In this study, a total of 181 samples were isolated from patients with CL lesions in four different endemic cities of Iran (Jahrom, Juyom, Kashan and Shoushtar) during the COVID-19 pandemic (the summer and autumn of 2021). The nested-PCR targeting kinetoplast DNA (kDNA) minicircles was applied for species identification of the parasite and the internal transcribed spacer-1 (ITS-1) gene was applied for sequencing and phylogenetic analysis. RESULTS Molecular detection of kDNA minicircles revealed that all isolates from the four cities were Leishmania major, indicating the ZCL pattern. Ten isolates were sequenced by the ITS-1 gene and deposited in GenBank [accession numbers: OL627363-72]. Sequencing and phylogenetic analysis displayed a high similarity rate of the isolates with sequences from other parts of Iran and Iraq. Over half of the patients (53.59%) had a single lesion, while 17.12, 14.92, 2.21 and 12.16% of cases had two, three, four and more than four lesions, respectively. About half of the patients (50.27%) had lesions on their hands, while the rest had lesions on multiple locations (19.34%), legs (16.58%), face (9.94%), ears (1.66%) and waist (2.21%). CONCLUSIONS This study revealed the occurrence of ZCL during the COVID-19 pandemic in four endemic regions of Iran. Strategies for prevention and control of the disease should be considered to mitigate the occurrence of ZCL.
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Affiliation(s)
- Samaneh Mazaherifar
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom 74148-46199, Iran
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom 74148-46199, Iran
| | - Kavous Solhjoo
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom 74148-46199, Iran
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom 74148-46199, Iran
| | - Sima Rasti
- Department of Parasitology and Mycology and Infectious Diseases Research Center, Faculty of Medicine, Kashan University of Medical Sciences, Kashan 8115187159, I.R.Iran
| | | | - Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom 74148-46199, Iran
- Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom 74148-46199, Iran
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22
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Tavares W, Morais J, Martins JF, Scalsky RJ, Stabler TC, Medeiros MM, Fortes FJ, Arez AP, Silva JC. Malaria in Angola: recent progress, challenges and future opportunities using parasite demography studies. Malar J 2022; 21:396. [PMID: 36577996 PMCID: PMC9795141 DOI: 10.1186/s12936-022-04424-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Over the past two decades, a considerable expansion of malaria interventions has occurred at the national level in Angola, together with cross-border initiatives and regional efforts in southern Africa. Currently, Angola aims to consolidate malaria control and to accelerate the transition from control to pre-elimination, along with other country members of the Elimination 8 initiative. However, the tremendous heterogeneity in malaria prevalence among Angolan provinces, as well as internal population movements and migration across borders, represent major challenges for the Angolan National Malaria Control Programme. This review aims to contribute to the understanding of factors underlying the complex malaria situation in Angola and to encourage future research studies on transmission dynamics and population structure of Plasmodium falciparum, important areas to complement host epidemiological information and to help reenergize the goal of malaria elimination in the country.
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Affiliation(s)
- Wilson Tavares
- grid.10772.330000000121511713Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
| | - Joana Morais
- Instituto Nacional de Investigação Em Saúde, INIS, Luanda, Angola
| | - José F. Martins
- Programa Nacional de Controlo da Malária, PNCM, Luanda, Angola
| | - Ryan J. Scalsky
- grid.411024.20000 0001 2175 4264Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA
| | - Thomas C. Stabler
- grid.416786.a0000 0004 0587 0574Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland ,grid.6612.30000 0004 1937 0642University of Basel, Basel, Switzerland
| | - Márcia M. Medeiros
- grid.10772.330000000121511713Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
| | - Filomeno J. Fortes
- grid.10772.330000000121511713Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
| | - Ana Paula Arez
- grid.10772.330000000121511713Global Health and Tropical Medicine, GHTM, Instituto de Higiene E Medicina Tropical, IHMT, Universidade NOVA de Lisboa, UNL, Lisbon, Portugal
| | - Joana C. Silva
- grid.411024.20000 0001 2175 4264Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, USA ,grid.411024.20000 0001 2175 4264Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, USA
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23
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Liu Q, Yan W, Qin C, Du M, Liu M, Liu J. Millions of excess cases and thousands of excess deaths of malaria occurred globally in 2020 during the COVID-19 pandemic. J Glob Health 2022; 12:05045. [PMID: 36527272 PMCID: PMC9757497 DOI: 10.7189/jogh.12.05045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The COVID-19 pandemic disrupted malaria-related health care services, leading to an excess burden of malaria. However, there is a lack of research on the indirect global impact of the COVID-19 pandemic on malaria. We aimed to assess the excess burden of malaria due to the COVID-19 pandemic in malaria-endemic countries in 2020. Methods Based on data from the World Health Organization Global Observatory, we used estimated annual percentage changes (EAPCs) from 2000 to 2019 (model A) and from 2015 to 2019 (model B) to predict the malaria burden in 2020. We calculated the ratios between reported and predicted malaria incidence (incidence rate ratio (IRR)) and mortality rates (mortality rate ratio (MRR)). Results In 2020, African countries suffered the most from malaria, with the largest number of malaria cases (64.7 million) and deaths (151 thousand) observed in Nigeria. Most countries showed a decrease in malaria incidence and mortality rates from 2000 to 2019, with the strongest decline in incidence rates in Bhutan (EAPC = -35.7%, 95% CI = -38.7 to -32.5%) and mortality rates Ecuador (EAPC = -40.6%, 95% confidence interval (CI) = -46.6 to -33.8%). During the COVID-19 pandemic in 2020, there was a total of 18 million excess malaria cases and 83 291 excess deaths per model A, and 7.4 million excess cases and 33 528 excess deaths per model B globally. Malaria incidence rates increased excessively in over 50% of the malaria-endemic countries, with the greatest increase in Costa Rica (IRR = 35.6) per model A and Bhutan (IRR = 15.6) per model B. Mortality rates had increased excessively in around 70% of the malaria-endemic countries, with the greatest increase in Ecuador in both model A (MRR = 580) and model B (MRR = 58). Conclusions The emergence of the COVID-19 pandemic indirectly caused an increase in the prevalence of malaria and thwarted progress in malaria control. Global efforts to control the pandemic's impact should be balanced with malaria control to ensure that the goal for global malaria elimination is achieved on time.
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Affiliation(s)
- Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenxin Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Chenyuan Qin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China,Global Center for Infectious Disease and Policy Research, Global Health and Infectious Diseases Group, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China,Global Center for Infectious Disease and Policy Research, Global Health and Infectious Diseases Group, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China
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24
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Transmission Dynamics of Monkeypox Virus in Nigeria during the Current COVID-19 Pandemic and Estimation of Effective Reproduction Number. Vaccines (Basel) 2022; 10:vaccines10122153. [PMID: 36560564 PMCID: PMC9781845 DOI: 10.3390/vaccines10122153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
Monkeypox virus (MPXV) continues to pose severe threats to global public health, especially in non-endemic areas. Like all other regions, Africa faces potential public health crises due to the ongoing COVID-19 pandemic and other infectious disease outbreaks (such as Lassa fever and malaria) that have devastated the region and overwhelmed the healthcare systems. Owing to the recent surge in the MPXV and other infections, the COVID-19-control efforts could deteriorate and further worsen. This study discusses the potential emergencies of MPXV transmission during the current COVID-19 pandemic. We hypothesize some of the underlying drivers that possibly resulted in an increase in rodent-to-human interaction, such as the COVID-19 pandemic's impact and other human behavioral or environmental factors. Furthermore, we estimate the MPXV time-varying effective reproduction number (Rt) based on case notification in Nigeria. We find that Rt reached a peak in 2022 with a mean of 1.924 (95% CrI: 1.455, 2.485) and a median of 1.921 (95% CrI: 1.450, 2.482). We argue that the real-time monitoring of Rt is practical and can give public health authorities crucial data for circumstantial awareness and strategy recalibration. We also emphasize the need to improve awareness programs and the provision of adequate health care resources to suppress the outbreaks. These could also help to increase the reporting rate and, in turn, prevent large community transmission of the MPXV in Nigeria and beyond.
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25
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López-Farfán D, Yerbanga RS, Parres-Mercader M, Torres-Puente M, Gómez-Navarro I, Sanou DMS, Yao AF, Bosco Ouédraogo J, Comas I, Irigoyen N, Gómez-Díaz E. Prevalence of SARS-CoV-2 and co-infection with malaria during the first wave of the pandemic (the Burkina Faso case). Front Public Health 2022; 10:1048404. [PMID: 36579069 PMCID: PMC9791192 DOI: 10.3389/fpubh.2022.1048404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
Africa accounts for 1.5% of the global coronavirus disease 2019 (COVID-19) cases and 2.7% of deaths, but this low incidence has been partly attributed to the limited testing capacity in most countries. In addition, the population in many African countries is at high risk of infection with endemic infectious diseases such as malaria. Our aim is to determine the prevalence and circulation of SARS-CoV-2 variants, and the frequency of co-infection with the malaria parasite. We conducted serological tests and microscopy examinations on 998 volunteers of different ages and sexes in a random and stratified population sample in Burkina-Faso. In addition, nasopharyngeal samples were taken for RT-qPCR of SARS-CoV-2 and for whole viral genome sequencing. Our results show a 3.2 and a 2.5% of SARS-CoV-2 seroprevalence and PCR positivity; and 22% of malaria incidence, over the sampling period, with marked differences linked to age. Importantly, we found 8 cases of confirmed co-infection and 11 cases of suspected co-infection mostly in children and teenagers. Finally, we report the genome sequences of 13 SARS-CoV-2 isolates circulating in Burkina Faso at the time of analysis, assigned to lineages A.19, A.21, B.1.1.404, B.1.1.118, B.1 and grouped into clades; 19B, 20A, and 20B. This is the first population-based study about SARS-CoV-2 and malaria in Burkina Faso during the first wave of the pandemic, providing a relevant estimation of the real prevalence of SARS-CoV-2 and variants circulating in this Western African country. Besides, it highlights the non-negligible frequency of co-infection with malaria in African communities.
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Affiliation(s)
- Diana López-Farfán
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN, CSIC), Granada, Spain
| | - R Serge Yerbanga
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso.,Institut des Sciences et Techniques (INSTech), Bobo-Dioulasso, Burkina Faso
| | - Marina Parres-Mercader
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN, CSIC), Granada, Spain
| | - Manuela Torres-Puente
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (IBV, CSIC), Valencia, Spain
| | - Inmaculada Gómez-Navarro
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (IBV, CSIC), Valencia, Spain
| | | | - Adama Franck Yao
- Institut de Recherche en Sciences de la Santé (IRSS), Bobo-Dioulasso, Burkina Faso
| | | | - Iñaki Comas
- Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Científicas (IBV, CSIC), Valencia, Spain.,Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CIBER), Madrid, Spain
| | - Nerea Irigoyen
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Elena Gómez-Díaz
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas (IPBLN, CSIC), Granada, Spain
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Habibi P, Shi Y, Fatima Grossi-de-Sa M, Khan I. Plants as Sources of Natural and Recombinant Antimalaria Agents. Mol Biotechnol 2022; 64:1177-1197. [PMID: 35488142 PMCID: PMC9053566 DOI: 10.1007/s12033-022-00499-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
Malaria is one of the severe infectious diseases that has victimized about half a civilization billion people each year worldwide. The application of long-lasting insecticides is the main strategy to control malaria; however, a surge in antimalarial drug development is also taking a leading role to break off the infections. Although, recurring drug resistance can compromise the efficiency of both conventional and novel antimalarial medicines. The eradication of malaria is significantly contingent on discovering novel potent agents that are low cost and easy to administer. In this context, plant metabolites inhibit malaria infection progression and might potentially be utilized as an alternative treatment for malaria, such as artemisinin. Advances in genetic engineering technology, especially the advent of molecular farming, have made plants more versatile in producing protein drugs (PDs) to treat infectious diseases, including malaria. These recent developments in genetic modifications have enabled the production of native pharmaceutically active compounds and the accumulation of diverse heterologous proteins such as human antibodies, booster vaccines, and many PDs to treat infectious diseases and genetic disorders. This review will discuss the pivotal role of a plant-based production system that expresses natural antimalarial agents or host protein drugs to cure malaria infections. The potential of these natural and induced compounds will support modern healthcare systems in treating malaria infections, especially in developing countries to mitigate human fatalities.
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Affiliation(s)
- Peyman Habibi
- Department of Pathology and Laboratory Medicine and Center for Cellular Immunotherapies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Yao Shi
- Department of Basic and Applied Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Maria Fatima Grossi-de-Sa
- Embrapa Genetic Resources and Biotechnology, Brasília-DF, Brazil
- Catholic University of Brasília, Brasília-DF, Brazil
- National Institute of Science and Technology, INCT Plant Stress Biotech, Embrapa, Brazil
| | - Imran Khan
- Department of Chemical Engineering, University of California, Davis, CA, USA.
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Elsamadony M, Fujii M, Ryo M, Nerini FF, Kakinuma K, Kanae S. Preliminary quantitative assessment of the multidimensional impact of the COVID-19 pandemic on Sustainable Development Goals. JOURNAL OF CLEANER PRODUCTION 2022; 372:133812. [PMID: 36061137 PMCID: PMC9418703 DOI: 10.1016/j.jclepro.2022.133812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 08/05/2022] [Accepted: 08/22/2022] [Indexed: 05/05/2023]
Abstract
The intersectoral impacts of the COVID-19 pandemic on humanity raises concerns about its implications for sustainable development. Here, we examine a global quantitative impact of COVID-19 pandemic on Sustainable Development Goals (SDGs) across all 17 goals using 65 proxy indicators across 72 countries collected from April 2020 to February 2021. Our data-driven analysis indicated that adverse impacts of the pandemic have been particularly concerned on gender equality (Goal 5), affordable and clean energy (Goal 7), decent work and economic growth (Goal 8), sustainable cities and communities (Goal 11), and responsible consumption and production (Goal 12) with global scores estimated to be -0.38, -0.21, -0.28, -0.22 and -0.16, respectively. Country income level was a variable that strongly differentiates the responses to the pandemic (e.g., lower incomes had 14 negative goals compared to 11 and 4 negative goals assigned to middle- and high-income countries, respectively). However, Goals 5 and 8 were highly impacted worldwide regardless of income status. Furthermore, countries that had already higher performance in SDGs were less impacted by the pandemic, highlighting the importance of progress on the SDGs in increasing societal resilience to pandemics. The findings provide insights into the reinforcement of recovery policies (e.g., protecting vulnerable groups and transitioning to a green economy) and a basis for a quantitative discussion on the sectors to be prioritized.
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Affiliation(s)
- Mohamed Elsamadony
- Civil and Environmental Engineering Department, School of Environment and Society, Tokyo Institute of Technology, Meguro-Ku, Tokyo, 152-8552, Japan
- Department of Public Works Engineering, Faculty of Engineering, Tanta University, 31521, Tanta City, Egypt
| | - Manabu Fujii
- Civil and Environmental Engineering Department, School of Environment and Society, Tokyo Institute of Technology, Meguro-Ku, Tokyo, 152-8552, Japan
| | - Masahiro Ryo
- Leibniz Centre for Agricultural Landscape Research (ZALF), Müncheberg, Germany
- Brandenburg University of Technology Cottbus-Senftenberg, Cottbus, Germany
| | - Francesco Fuso Nerini
- KTH Climate Action Centre & KTH Division of Energy Systems, KTH Royal Institute of Technology, SE-100 44, Stockholm, Sweden
| | - Kaoru Kakinuma
- Asian Demographic Research Institute, Shanghai University, Shanghai, PR China
| | - Shinjiro Kanae
- Civil and Environmental Engineering Department, School of Environment and Society, Tokyo Institute of Technology, Meguro-Ku, Tokyo, 152-8552, Japan
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Emmanuel S, Loy AA, Patrickson A. Utilization of ART Services Among People Living with HIV During the COVID-19 Pandemic: A Case of Kampala District. Open AIDS J 2022. [DOI: 10.2174/18746136-v16-e2208170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
The intense pressure on the health system coupled with strict measures have interrupted ART service utility during the COVID 19 pandemic. In this study, we assessed the Utilization of ART services among People Living with HIV during the COVID-19 pandemic in Kampala District, Uganda.
Methods:
We studied 9952 records of patient encounters between 24th March and 1st June 2020 from the Open Medical Records System (EMR) and obtained an analytical sample of 647 encounters for PLHIV enrolled in Kampala district; 243 from the Mbuya site, 274 from Kinawataka site and 130 from Banda site. We assessed factors associated with inadequate ART utilization using the modified poison regression (generalized linear model with a poisoned family and a log link) and reported clustered robust standard errors with their corresponding Prevalence Ratios.
Results and Discussion:
The rate of ART utilization during the COVID-19 pandemic in the Kampala district was inadequate (14.71%). PLHIV who were in WHO clinical stage 3 had aPR=18.065, 95%CI=17.396 18.759, and P-value =0.001 as compared to those in WHO stage 1. PLHIV who were obese had aPR=1.439, 95% CI=1.103 1.879, P-value =0.007 as compared to those with normal BMI.
Conclusion:
The factors associated with inadequate ART utilization were body mass index and WHO clinical staging of the disease. This information is crucial for strengthening HIV programs and interventions in terms of access to ART services, with a focus on obese infected individuals and those with advanced HIV disease during pandemics that require lock-down measures.
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Chang T, Jung BK, Chai JY, Cho SI. The notable global heterogeneity in the distribution of COVID-19 cases and the association with pre-existing parasitic diseases. PLoS Negl Trop Dis 2022; 16:e0010826. [PMID: 36215332 PMCID: PMC9584393 DOI: 10.1371/journal.pntd.0010826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/20/2022] [Accepted: 09/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The coronavirus Disease 2019 (COVID-19) is a respiratory disease that has caused extensive ravages worldwide since being declared a pandemic by the World Health Organization (WHO). Unlike initially predicted by WHO, the incidence and severity of COVID-19 appeared milder in many Low-to-Middle-Income Countries (LMIC). To explain this noticeable disparity between countries, many hypotheses, including socio-demographic and geographic factors, have been put forward. This study aimed to estimate the possible association of parasitic diseases with COVID-19 as either protective agents or potential risk factors. METHODS/PRINCIPAL FINDINGS A country-level ecological study using publicly available data of countries was conducted. We conceptualized the true number of COVID-19 infections based on a function of test positivity rate (TPR) and employed linear regression analysis to assess the association between the outcome and parasitic diseases. We considered demographic, socioeconomic, and geographic confounders previously suggested. A notable heterogeneity was observed across WHO regions. The countries in Africa (AFRO) showed the lowest rates of COVID-19 incidence, and the countries in the Americas (AMRO) presented the highest. The multivariable model results were computed using 165 countries, excluding missing values. In the models analyzed, lower COVID-19 incidence rates were consistently observed in malaria-endemic countries, even accounting for potential confounding variables, Gross Domestic Product (GDP) per capita, the population aged 65 and above, and differences in the duration of COVID-19. However, the other parasitic diseases were not significantly associated with the spread of the pandemic. CONCLUSIONS/SIGNIFICANCE This study suggests that malaria prevalence is an essential factor that explains variability in the observed incidence of COVID-19 cases at the national level. Potential associations of COVID-19 with schistosomiasis and soil-transmitted helminthiases (STHs) are worthy of further investigation but appeared unlikely, based on this analysis, to be critical factors of the variability in COVID-19 epidemic trends. The quality of publicly accessible data and its ecological design constrained our research, with fundamental disparities in monitoring and testing capabilities between countries. Research at the subnational or individual level should be conducted to explore hypotheses further.
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Affiliation(s)
- Taehee Chang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Bong-Kwang Jung
- Institute of Parasitic Diseases, Korea Association of Health Promotion, Seoul, Republic of Korea
| | - Jong-Yil Chai
- Department of Tropical Medicine and Parasitology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-il Cho
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- * E-mail:
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30
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Needle-free, spirulina-produced Plasmodium falciparum circumsporozoite vaccination provides sterile protection against pre-erythrocytic malaria in mice. NPJ Vaccines 2022; 7:113. [PMID: 36195607 PMCID: PMC9532447 DOI: 10.1038/s41541-022-00534-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/05/2022] [Indexed: 02/02/2023] Open
Abstract
Antibodies against the Plasmodium falciparum circumsporozoite protein (PfCSP) can block hepatocyte infection by sporozoites and protect against malaria. Needle-free vaccination strategies are desirable, yet most PfCSP-targeted vaccines like RTS,S require needle-based administration. Here, we evaluated the edible algae, Arthrospira platensis (commonly called 'spirulina') as a malaria vaccine platform. Spirulina were genetically engineered to express virus-like particles (VLPs) consisting of the woodchuck hepatitis B core capsid protein (WHcAg) displaying a (NANP)15 PfCSP antigen on its surface. PfCSP-spirulina administered to mice intranasally followed by oral PfCSP-spirulina boosters resulted in a strong, systemic anti-PfCSP immune response that was protective against subcutaneous challenge with PfCSP-expressing P. yoelii. Unlike male mice, female mice did not require Montanide adjuvant to reach high antibody titers or protection. The successful use of spirulina as a vaccine delivery system warrants further development of spirulina-based vaccines as a useful tool in addressing malaria and other diseases of global health importance.
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31
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Matowo NS, Tanner M, Temba BA, Finda M, Mlacha YP, Utzinger J, Okumu FO. Participatory approaches for raising awareness among subsistence farmers in Tanzania about the spread of insecticide resistance in malaria vectors and the possible link to improper agricultural pesticide use. Malar J 2022; 21:277. [PMID: 36180865 PMCID: PMC9524312 DOI: 10.1186/s12936-022-04289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Insecticide resistance is a key barrier to long-term malaria control, and it may be exacerbated by poor agricultural pesticide use. Current practices, however, do not link public health and agricultural pesticide use. This study investigated the perspectives of farmers and other stakeholders regarding the integration of agricultural and public health measures to address resistance. Additionally, the feasibility of participatory workshops to increase the farmers’ understanding and participation in pesticide stewardship was assessed. Methods Four themes were investigated: pesticide awareness, practices, and opinions of; insecticide resistance in malaria vectors; the effectiveness of current malaria prevention tools; and the links between agricultural and public health pesticide usage. Participatory workshops and field training were held with entomologists, farmers, and agricultural specialists, focusing on agro-ecosystem practices related to pest control; and local farmers were involved in live-testing for insecticides resistance of local Anopheles mosquitoes. Results Most farmers (94%) considered pesticides effective, and nearly half of them (n = 198, 46.4%) could identify and name crop pests and diseases, mostly using local names. Three quarters were unaware of mosquito larvae in their fields, and only 7% considered their fields as potential sources of mosquitoes. Two thirds were uninformed of any effects that agricultural pesticides may have on mosquitoes, and three quarters had never heard of resistance in malaria mosquitoes. Experts from various sectors acknowledged that agricultural pesticides might impact malaria control through increasing resistance. They did, however, emphasize the importance of crop protection and advocated for the use of pesticides sparingly and non-chemical approaches. Farmers learnt how to discriminate between malaria vectors and non-vectors, identify agricultural pests and diseases, choose and use pesticides effectively, and conduct resistance tests during the participatory workshops. Conclusion This study emphasizes the significance of enhancing subsistence farmers’ awareness of mosquito ecology as well as merging public health and agricultural pest management measures. Participatory techniques have the potential to raise stakeholder awareness and engagement, resulting in more effective resistance management.
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Affiliation(s)
- Nancy Stephen Matowo
- Environmental and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania. .,Swiss Tropical and Public Health Institute, Allschwil, Switzerland. .,University of Basel, Basel, Switzerland. .,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Benigni Alfred Temba
- Department of Veterinary Physiology, Pharmacology and Toxicology, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Marceline Finda
- Environmental and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania
| | - Yeromin Paul Mlacha
- Environmental and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania.,Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.,University of Basel, Basel, Switzerland
| | - Fredros Oketch Okumu
- Environmental and Ecological Sciences Department, Ifakara Health Institute, Ifakara, Tanzania.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, UK
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32
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Kanoi BN, Maina M, Likhovole C, Kobia FM, Gitaka J. Malaria vaccine approaches leveraging technologies optimized in the COVID-19 era. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.988665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Africa bears the greatest burden of malaria with more than 200 million clinical cases and more than 600,000 deaths in 2020 alone. While malaria-associated deaths dropped steadily until 2015, the decline started to falter after 2016, highlighting the need for novel potent tools in the fight against malaria. Currently available tools, such as antimalarial drugs and insecticides are threatened by development of resistance by the parasite and the mosquito. The WHO has recently approved RTS,S as the first malaria vaccine for public health use. However, because the RTS,S vaccine has an efficacy of only 36% in young children, there is need for more efficacious vaccines. Indeed, based on the global goal of licensing a malaria vaccine with at least 75% efficacy by 2030, RTS,S is unlikely to be sufficient alone. However, recent years have seen tremendous progress in vaccine development. Although the COVID-19 pandemic impacted malaria control, the rapid progress in research towards the development of COVID-19 vaccines indicate that harnessing funds and technological advances can remarkably expedite vaccine development. In this review, we highlight and discuss current and prospective trends in global efforts to discover and develop malaria vaccines through leveraging mRNA vaccine platforms and other systems optimized during COVID-19 vaccine studies.
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33
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Dorkenoo AM, Gbeasor-Komlanvi FA, Gbada K, Zida-Compaore WIC, Teou D, Konu YR, Lack F, Sadio AJ, Tchankoni MK, Dagnra AC, Ekouevi DK. Prevalence of Malaria and Covid-19 in Febrile Patients in Lomé, Togo in 2020. Acta Parasitol 2022; 67:1335-1342. [PMID: 35834159 PMCID: PMC9281227 DOI: 10.1007/s11686-022-00586-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE The objective of this study was to estimate the prevalence of malaria and Covid-19 by PCR and serological tests in febrile patients in Lomé. METHODS A cross-sectional study was conducted from September 1 to October 31, 2020 in febrile patients ≥ 10 years in three health facilities in Lomé. Finger stick blood was collected to detect Plasmodium spp. using thin/thick smear and venous blood on EDTA tubes to test for malaria Histidin-Rich-Protein-2 antigen using rapid diagnostic tests (RDT) and SARS-CoV-2 antibodies specific immunoglobulin (Ig) M and G. Detection of SARS-CoV-2 in nasopharyngeal samples was performed by rRT-PCR using GeneXpert. RESULTS A total of 243 participants (61.7% of female) with median age 28 years (IQR 18-41) were included in the study. Prevalence of malaria was 25.1%, 95% CI [19.8-31.0] and 30.4%, 95% CI [24.7-36.7] for thin/thick smear and rapid malaria test, respectively. Eighteen patients (7.4%, 95% CI [4.4-11.5]) were positive for SARS-CoV-2 and forty-two (17.3%, 95% CI [12.8-22.6]) were positive for IgM and/or IgG against SARS-CoV-2. SARS-CoV-2 IgM seroprevalence was significantly higher in malaria RDT positive participants (33.8% vs. 10.1%, p < 0.001). CONCLUSION This study confirms a possible cross-reactivity between Covid-19 and malaria in case of single use of rapid tests, suggesting a possible past contamination. In case of clinical signs related to Covid-19 in malaria-endemic areas, PCR screening should be requested in order to identify and isolate patients.
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Affiliation(s)
- Ameyo Monique Dorkenoo
- Department of Parasitology, University of Lomé, Lomé, Togo.
- Direction of Laboratories, Ministry of Health, Public Hygiene, and Universal Health Coverage, Lomé, Togo.
| | | | - Komivi Gbada
- Department of Parasitology, University of Lomé, Lomé, Togo
| | | | - Diwaba Teou
- Direction of Laboratories, Ministry of Health, Public Hygiene, and Universal Health Coverage, Lomé, Togo
| | - Yao Rodion Konu
- Department of Public Health, University of Lomé, Lomé, Togo
- African Center for Research in Epidemiology and Public Health, Lomé, Togo
| | - Fiali Lack
- Direction of Laboratories, Ministry of Health, Public Hygiene, and Universal Health Coverage, Lomé, Togo
| | - Arnold Junior Sadio
- Department of Public Health, University of Lomé, Lomé, Togo
- African Center for Research in Epidemiology and Public Health, Lomé, Togo
| | | | - Anoumou Claver Dagnra
- National Mycobacteria Reference Laboratory, Ministry of Health, Public Hygiene, and Universal Health Coverage, Lomé, Togo
| | - Didier Koumavi Ekouevi
- Department of Public Health, University of Lomé, Lomé, Togo
- African Center for Research in Epidemiology and Public Health, Lomé, Togo
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Barocas JA, Savinkina A, Lodi S, Epstein RL, Bouton TC, Sperring H, Hsu HE, Jacobson KR, Schechter-Perkins EM, Linas BP, White LF. Projected Long-Term Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Hepatitis C Outcomes in the United States: A Modeling Study. Clin Infect Dis 2022; 75:e1112-e1119. [PMID: 34499124 PMCID: PMC8522427 DOI: 10.1093/cid/ciab779] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic disrupted access to and uptake of hepatitis C virus (HCV) care services in the United States. It is unknown how substantially the pandemic will impact long-term HCV-related outcomes. METHODS We used a microsimulation to estimate the 10-year impact of COVID-19 disruptions in healthcare delivery on HCV outcomes including identified infections, linkage to care, treatment initiation and completion, cirrhosis, and liver-related death. We modeled hypothetical scenarios consisting of an 18-month pandemic-related disruption in HCV care starting in March 2020 followed by varying returns to pre-pandemic rates of screening, linkage, and treatment through March 2030 and compared them to a counterfactual scenario in which there was no COVID-19 pandemic or disruptions in care. We also performed alternate scenario analyses in which the pandemic disruption lasted for 12 and 24 months. RESULTS Compared to the "no pandemic" scenario, in the scenario in which there is no return to pre-pandemic levels of HCV care delivery, we estimate 1060 fewer identified cases, 21 additional cases of cirrhosis, and 16 additional liver-related deaths per 100 000 people. Only 3% of identified cases initiate treatment and <1% achieve sustained virologic response (SVR). Compared to "no pandemic," the best-case scenario in which an 18-month care disruption is followed by a return to pre-pandemic levels, we estimated a smaller proportion of infections identified and achieving SVR. CONCLUSIONS A recommitment to the HCV epidemic in the United States that involves additional resources coupled with aggressive efforts to screen, link, and treat people with HCV is needed to overcome the COVID-19-related disruptions.
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Affiliation(s)
- Joshua A Barocas
- Division of General Internal Medicine and Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rachel L Epstein
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA
- Boston University School of Medicine (BUSM), Boston, Massachusetts, USA
| | - Tara C Bouton
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA
- Boston University School of Medicine (BUSM), Boston, Massachusetts, USA
| | - Heather Sperring
- Boston University School of Medicine (BUSM), Boston, Massachusetts, USA
| | - Heather E Hsu
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA
- Department of Pediatrics, BMC, Boston, Massachusetts, USA
| | - Karen R Jacobson
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA
- Boston University School of Medicine (BUSM), Boston, Massachusetts, USA
| | - Elissa M Schechter-Perkins
- Boston University School of Medicine (BUSM), Boston, Massachusetts, USA
- Department of Emergency Medicine, BMC, Boston, Massachusetts, USA
| | - Benjamin P Linas
- Section of Infectious Diseases, Boston Medical Center (BMC), Boston, Massachusetts, USA
- Boston University School of Medicine (BUSM), Boston, Massachusetts, USA
| | - Laura F White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
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35
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Okumu F, Gyapong M, Casamitjana N, Castro MC, Itoe MA, Okonofua F, Tanner M. What Africa can do to accelerate and sustain progress against malaria. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000262. [PMID: 36962314 PMCID: PMC10021840 DOI: 10.1371/journal.pgph.0000262] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
After a longstanding global presence, malaria is now largely non-existent or suppressed in most parts of the world. Today, cases and deaths are primarily concentrated in sub-Saharan Africa. According to many experts, this persistence on the African continent reflects factors such as resistance to insecticides and drugs as well as insufficient access to essential commodities such as insecticide-treated nets and effective drugs. Crucially, however, this narrative ignores many central weaknesses in the fight against malaria and instead reinforces a narrow, commodity-driven vision of disease control. This paper therefore describes the core challenges hindering malaria programs in Africa and highlights key opportunities to rethink current strategies for sustainable control and elimination. The epidemiology of malaria in Africa presents far greater challenges than elsewhere and requires context-specific initiatives tailored to national and sub-national targets. To sustain progress, African countries must systematically address key weaknesses in its health systems, improve the quality and use of data for surveillance-responses, improve both technical and leadership competencies for malaria control, and gradually reduce overreliance on commodities while expanding multisectoral initiatives such as improved housing and environmental sanitation. They must also leverage increased funding from both domestic and international sources, and support pivotal research and development efforts locally. Effective vaccines and drugs, or other potentially transformative technologies such as genedrive modified mosquitoes, could further accelerate malaria control by complementing current tools. However, our underlying strategies remain insufficient and must be expanded to include more holistic and context-specific approaches critical to achieve and sustain effective malaria control.
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Affiliation(s)
| | - Margaret Gyapong
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Núria Casamitjana
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic–University of Barcelona, Barcelona, Spain
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Maurice A. Itoe
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Friday Okonofua
- Department of Obstetrics and Gynaecology, School of Medicine, University of Benin, Benin City, Nigeria
| | - Marcel Tanner
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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36
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Azizi S, Snetselaar J, Kaaya R, Matowo J, Onen H, Shayo M, Kisengwa E, Tilya E, Manunda B, Mawa B, Mosha F, Kirby M. Implementing OECD GLP principles for the evaluation of novel vector control tools: a case study with two novel LLINs, SafeNet ® and SafeNet NF ®. Malar J 2022; 21:183. [PMID: 35690824 PMCID: PMC9188019 DOI: 10.1186/s12936-022-04208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To sustain high universal Long-Lasting Insecticidal Nets (LLINs) coverage, affordable nets that provide equivalent or better protection than standard LLINs, are required. Test facilities evaluating new LLINs require compliance to Good Laboratory Practice (GLP) standards to ensure the quality and integrity of test data. Following GLP principles allows for the reconstruction of activities during the conduct of a study and minimizes duplication of efficacy testing. This case study evaluated the efficacy of two LLINs: SafeNet NF® and SafeNet® LLIN. METHODS The study was conducted according to GLP principles and followed World Health Organization guidelines for evaluating LLINs. The LLINs were assessed in experimental huts against wild, pyrethroid-resistant Anopheles arabiensis mosquitoes. Nets were either unwashed or washed 20 times and artificially holed to simulate a used torn net. Blood-feeding inhibition and mortality were compared with a positive control (Interceptor® LLIN) and an untreated net. RESULTS Mosquito entry in the huts was reduced compared to negative control for the unwashed SafeNet NF, washed Safenet LLIN and the positive control arms. Similar exiting rates were found for all the treatment arms. Significant blood-feeding inhibition was only found for the positive control, both when washed and unwashed. All insecticide treatments induced significantly higher mortality compared to an untreated net. Compared to the positive control, the washed and unwashed SafeNet NF® resulted in similar mortality. For the SafeNet® LLINs the unwashed net had an equivalent performance, but the mortality for the washed net was significantly lower than the positive control. Internal audits of the study confirmed that all critical phases complied with Standard Operating Procedures (SOPs) and the study plan. The external audit confirmed that the study complied with GLP standards. CONCLUSIONS SafeNet NF® and SafeNet® LLIN offered equivalent protection to the positive control (Interceptor® LLIN). However, further research is needed to investigate the durability, acceptability, and residual efficacy of these nets in the community. This study demonstrated that GLP-compliant evaluation of LLINs can be successfully conducted by African research institutions.
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Affiliation(s)
- Salum Azizi
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania. .,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania.
| | - Janneke Snetselaar
- Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania.,Innovative Vector Control Consortium (IVCC), Liverpool, L3 5QA, UK.,London School of Hygiene and Tropical Medicine (LSHTM), London, WC1E 7HT, UK
| | - Robert Kaaya
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Johnson Matowo
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Hudson Onen
- Department of Zoology, Entomology and Fisheries Sciences, College of Natural Sciences, School of Biosciences, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Magreth Shayo
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Ezekia Kisengwa
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Evod Tilya
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Baltazari Manunda
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Benson Mawa
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Franklin Mosha
- Department of Medical Parasitology and Entomology, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, 255, Tanzania.,Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania
| | - Matthew Kirby
- Pan African Malaria Vector Research Consortium (PAMVERC), Moshi, 255, Tanzania.,Innovative Vector Control Consortium (IVCC), Liverpool, L3 5QA, UK
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Rodo M, Singh L, Russell N, Singh NS. A mixed methods study to assess the impact of COVID-19 on maternal, newborn, child health and nutrition in fragile and conflict-affected settings. Confl Health 2022; 16:30. [PMID: 35659039 PMCID: PMC9162897 DOI: 10.1186/s13031-022-00465-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The impacts of COVID-19 are unprecedented globally. The pandemic is reversing decades of progress in maternal, newborn, child health and nutrition (MNCHN), especially fragile and conflict-affected settings (FCAS) whose populations were already facing challenges in accessing basic health and nutrition services. This study aimed to investigate the collateral impact of COVID-19 on funding, services and MNCHN outcomes in FCAS, as well as adaptations used in the field to continue activities. METHODS A scoping review of peer-reviewed and grey literature published between 1st March 2020-31st January 2021 was conducted. We analysed 103 publications using a narrative synthesis approach. 39 remote semi-structured key informant interviews with humanitarian actors and donor staff within 12 FCAS were conducted between October 2020 and February 2021. Thematic analysis was undertaken independently by two researchers on interview transcripts and supporting documents provided by key informants, and triangulated with literature review findings. RESULTS Funding for MNCHN has been reduced or suspended with increase in cost of continuing the same activities, and diversion of MNCHN funding to COVID-19 activities. Disruption in supply and demand of interventions was reported across different settings which, despite data evidence still being missing, points towards likely increased maternal and child morbidity and mortality. Some positive adaptations including use of technology and decentralisation of services have been reported, however overall adaptation strategies have been insufficient to equitably meet additional challenges posed by the pandemic, and have not been evaluated for their effectiveness. CONCLUSIONS COVID-19 is further exacerbating negative women's and children's health outcomes in FCAS. Increased funding is urgently required to re-establish MNCHN activities which have been deprioritised or halted. Improved planning to sustain routine health services and enable surge planning for emergencies with focus on the community/service users throughout adaptations is vital for improved MNCHN outcomes in FCAS.
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Affiliation(s)
- Mariana Rodo
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Lucy Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Neha S Singh
- Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK.
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Arsenault C, Gage A, Kim MK, Kapoor NR, Akweongo P, Amponsah F, Aryal A, Asai D, Awoonor-Williams JK, Ayele W, Bedregal P, Doubova SV, Dulal M, Gadeka DD, Gordon-Strachan G, Mariam DH, Hensman D, Joseph JP, Kaewkamjornchai P, Eshetu MK, Gelaw SK, Kubota S, Leerapan B, Margozzini P, Mebratie AD, Mehata S, Moshabela M, Mthethwa L, Nega A, Oh J, Park S, Passi-Solar Á, Pérez-Cuevas R, Phengsavanh A, Reddy T, Rittiphairoj T, Sapag JC, Thermidor R, Tlou B, Valenzuela Guiñez F, Bauhoff S, Kruk ME. COVID-19 and resilience of healthcare systems in ten countries. Nat Med 2022; 28:1314-1324. [PMID: 35288697 PMCID: PMC9205770 DOI: 10.1038/s41591-022-01750-1] [Citation(s) in RCA: 153] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/17/2022] [Indexed: 02/07/2023]
Abstract
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA.
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Min Kyung Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | | | - Freddie Amponsah
- Policy, Planning, Monitoring and Evaluation, Ghana Health Services, Accra, Ghana
| | - Amit Aryal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | | | - Wondimu Ayele
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paula Bedregal
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Mahesh Dulal
- Office of the Member of Federal Parliament Gagan Kumar Thapa, Kathmandu, Nepal
| | | | | | | | - Dilipkumar Hensman
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Jean Paul Joseph
- Hôpital Universitaire de Mirebalais, Zanmi Lasante, Arrondissement de Mirebalais, Mirebalais, Haïti
| | | | | | | | - Shogo Kubota
- World Health Organization, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Madidol University, Bangkok, Thailand
| | - Paula Margozzini
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Adiam Nega
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Sookyung Park
- Korea National Health Insurance Services, Health Insurance Research Institute, Gangwon-do, South Korea
| | - Álvaro Passi-Solar
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Pérez-Cuevas
- Division of Social Protection and Health, Inter-American Development Bank, Kingston, Jamaica
| | - Alongkhone Phengsavanh
- Faculty of Medicine, University of Health Sciences, Vientiane, Lao People's Democratic Republic, Vientiane, Laos
| | - Tarylee Reddy
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | | | - Jaime C Sapag
- Public Health Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Boikhutso Tlou
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Sebastian Bauhoff
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston MA, USA
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Omame A, Abbas M, Onyenegecha CP. Backward bifurcation and optimal control in a co-infection model for SARS-CoV-2 and ZIKV. RESULTS IN PHYSICS 2022; 37:105481. [PMID: 35433239 PMCID: PMC8994284 DOI: 10.1016/j.rinp.2022.105481] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/27/2022] [Accepted: 04/02/2022] [Indexed: 05/06/2023]
Abstract
In co-infection models for two diseases, it is mostly claimed that, the dynamical behavior of the sub-models usually predict or drive the behavior of the complete models. However, under a certain assumption such as, allowing incident co-infection with both diseases, we have a different observation. In this paper, a new mathematical model for SARS-CoV-2 and Zika co-dynamics is presented which incorporates incident co-infection by susceptible individuals. It is worth mentioning that the assumption is missing in many existing co-infection models. We shall discuss the impact of this assumption on the dynamics of a co-infection model. The model also captures sexual transmission of Zika virus. The positivity and boundedness of solution of the proposed model are studied, in addition to the local asymptotic stability analysis. The model is shown to exhibit backward bifurcation caused by the disease-induced death rates and parameters associated with susceptibility to a second infection by those singly infected. Using Lyapunov functions, the disease free and endemic equilibria are shown to be globally asymptotically stable for R 0 1 , respectively. To manage the co-circulation of both infections effectively, under an endemic setting, time dependent controls in the form of SARS-CoV-2, Zika and co-infection prevention strategies are incorporated into the model. The simulations show that SARS-CoV-2 prevention could greatly reduce the burden of co-infections with Zika. Furthermore, it is also shown that prevention controls for Zika can significantly decrease the burden of co-infections with SARS-CoV-2.
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Affiliation(s)
- Andrew Omame
- Department of Mathematics, Federal University of Technology, Owerri, Nigeria
- Abdus Salam School of Mathematical Sciences, Government College University Katchery Road, Lahore 54000, Pakistan
| | - Mujahid Abbas
- Department of Mathematics, Government College University Katchery Road, Lahore 54000, Pakistan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
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Monroe A, Williams NA, Ogoma S, Karema C, Okumu F. Reflections on the 2021 World Malaria Report and the future of malaria control. Malar J 2022; 21:154. [PMID: 35624483 PMCID: PMC9137259 DOI: 10.1186/s12936-022-04178-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The World Malaria Report, released in December 2021, reflects the unique challenges currently facing the global malaria community. The report showed the devastating toll of malaria, with an estimated 627,000 people losing their lives to the disease in 2020. The improved methodological approach used for calculating cause of death for young children revealed a systematic underestimation of disease burden over the past two decades; and that Africa has an even greater malaria crisis than previously known. While countries were able to prevent the worst-case scenarios, the disruptions due to the COVID-19 pandemic revealed how weak health systems and inadequate financing can limit the capacity of the continent to address the malaria challenge. African countries also face a convergence of biological threats that could redefine malaria control, notably widespread pyrethroid resistance and emerging resistance to artemisinin. Despite these challenges, there is cause for optimism in lessons learned from the COVID-19 pandemic, recent acceleration of cutting edge research and development, and new partnerships that encourage leadership from and ownership by affected countries. This article presents key insights from the 2021 World Malaria Report and reflections on the future trajectories: it was informed by an in-depth discussion with leading malaria experts from the World Health Organization (WHO), the Bill & Melinda Gates Foundation, and the U.S. President's Malaria Initiative (PMI). The discussion took place during the 34th edition of the Ifakara Master Classes, held virtually on December 15th, 2021.
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Affiliation(s)
- April Monroe
- Johns Hopkins Center for Communication Programs, Baltimore, USA.,Ifakara Health Institute, Ifakara, Tanzania
| | - Nana Aba Williams
- MESA Alliance, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.,Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | | | - Corine Karema
- Quality and Equity Healthcare, Kigali, Rwanda.,Swiss Tropical & Public Health Institute, Basel, Switzerland
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Heuschen AK, Abdul-Mumin A, Adokiya M, Lu G, Jahn A, Razum O, Winkler V, Müller O. Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: a retrospective analysis of routine surveillance data. Malar J 2022; 21:149. [PMID: 35570272 PMCID: PMC9107588 DOI: 10.1186/s12936-022-04154-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic and its collateral damage severely impact health systems globally and risk to worsen the malaria situation in endemic countries. Malaria is a leading cause of morbidity and mortality in Ghana. This study aims to describe the potential effects of the COVID-19 pandemic on malaria cases observed in health facilities in the Northern Region of Ghana. Methods Monthly routine data from the District Health Information Management System II (DHIMS2) of the Northern Region of Ghana were analysed. Overall outpatient department visits (OPD) and malaria case rates from the years 2015–2019 were compared to the corresponding data of the year 2020. Results Compared to the corresponding periods of the years 2015–2019, overall visits and malaria cases in paediatric and adult OPDs in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Cases slightly rebounded afterwards in 2020, but stayed below the average of the previous years. Malaria data from inpatient departments showed a similar but more pronounced trend when compared to OPDs. In pregnant women, however, malaria cases in OPDs increased after the first COVID-19 wave. Conclusions The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of northern Ghana, with declines in inpatient and outpatient rates except for pregnant women. They may have experienced reduced access to insecticide-treated nets and intermittent preventive malaria treatment in pregnancy, resulting in subsequent higher malaria morbidity. Further data, particularly from community-based studies and ideally complemented by qualitative research, are needed to fully determine the impact of the pandemic on the malaria situation in Africa.
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Rodrigues ABB, de Abreu-Fernandes R, Neto Z, Jandondo D, Almeida-de-Oliveira NK, de Lavigne Mello AR, Morais J, Daniel-Ribeiro CT, Menard D, Ferreira-da-Cruz MDF. Pfkelch13 Plasmodium falciparum Mutations in Huambo, Angola. Pathogens 2022; 11:554. [PMID: 35631076 PMCID: PMC9146480 DOI: 10.3390/pathogens11050554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 05/04/2022] [Indexed: 02/05/2023] Open
Abstract
Artemisinin (ART) is recommended as the first-line drug for P. falciparum infections combined with a long-acting partner drug. The emergence of P. falciparum resistance to ART (ARTR) is a concern for malaria. The most feared threat remains the spread of ARTR from Southeast Asia to Africa or the independent emergence of ARTR in Africa, where malaria accounts for 93% of all malaria cases and 94% of deaths. To avoid this worst-case scenario, surveillance of Pfkelch13 mutations is essential. We investigated mutations of Pfkelch13 in 78 P. falciparum samples from Huambo, Angola. Most of the parasites had a wild-type Pfkelch13 allele. We identified one synonymous mutation (R471R) in 10 isolates and one non-synonymous mutation (A578S) in two samples. No Pfkelch13 validated or candidate ARTR mutants were identified. The finding suggests that there is little polymorphism in Pfkelch13 in Huambo. Since cases of late response to ART in Africa and the emergence of ARTR mutations in Rwanda and Uganda have been reported, efforts should be made toward continuous molecular surveillance of ARTR. Our study has some limitations. Since we analyzed P. falciparum parasites from a single health facility, the study may not be representative of all Angolan endemic areas.
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Affiliation(s)
- Ana Beatriz Batista Rodrigues
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21040-900, Brazil; (A.B.B.R.); (R.d.A.-F.); (N.K.A.-d.-O.); (A.R.d.L.M.); (C.T.D.-R.)
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, SVS & Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Rebecca de Abreu-Fernandes
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21040-900, Brazil; (A.B.B.R.); (R.d.A.-F.); (N.K.A.-d.-O.); (A.R.d.L.M.); (C.T.D.-R.)
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, SVS & Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Zoraima Neto
- Instituto Nacional de Investigação em Saúde (INIS), Ministério da Saúde, Luanda 999104, Angola; (Z.N.); (D.J.); (J.M.)
| | - Domingos Jandondo
- Instituto Nacional de Investigação em Saúde (INIS), Ministério da Saúde, Luanda 999104, Angola; (Z.N.); (D.J.); (J.M.)
| | - Natália Ketrin Almeida-de-Oliveira
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21040-900, Brazil; (A.B.B.R.); (R.d.A.-F.); (N.K.A.-d.-O.); (A.R.d.L.M.); (C.T.D.-R.)
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, SVS & Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Aline Rosa de Lavigne Mello
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21040-900, Brazil; (A.B.B.R.); (R.d.A.-F.); (N.K.A.-d.-O.); (A.R.d.L.M.); (C.T.D.-R.)
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, SVS & Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Joana Morais
- Instituto Nacional de Investigação em Saúde (INIS), Ministério da Saúde, Luanda 999104, Angola; (Z.N.); (D.J.); (J.M.)
| | - Cláudio Tadeu Daniel-Ribeiro
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21040-900, Brazil; (A.B.B.R.); (R.d.A.-F.); (N.K.A.-d.-O.); (A.R.d.L.M.); (C.T.D.-R.)
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, SVS & Fiocruz, Rio de Janeiro 21040-900, Brazil
| | - Didier Menard
- Institut Pasteur, INSERM U1201, 75015 Paris, France;
- Institute of Parasitology and Tropical Diseases, UR7292, Dynamics of Host-Pathogen Interactions, Federation of Translational Medicine, University of Strasbourg, 67081 Strasbourg, France
- Laboratory of Parasitology and Medical Mycology, Strasbourg University Hospital, 67081 Strasbourg, France
| | - Maria de Fátima Ferreira-da-Cruz
- Laboratório de Pesquisa em Malária, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro 21040-900, Brazil; (A.B.B.R.); (R.d.A.-F.); (N.K.A.-d.-O.); (A.R.d.L.M.); (C.T.D.-R.)
- Centro de Pesquisa, Diagnóstico e Treinamento em Malária (CPD-Mal)/Reference Center for Malaria in the Extra-Amazonian Region of the Brazilian Ministry of Health, SVS & Fiocruz, Rio de Janeiro 21040-900, Brazil
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Camprubí-Ferrer D, Cobuccio L, Van Den Broucke S, Genton B, Bottieau E, d'Acremont V, Rodriguez-Valero N, Almuedo-Riera A, Balerdi-Sarasola L, Subirà C, Fernandez-Pardos M, Martinez MJ, Navero-Castillejos J, Vera I, Llenas-Garcia J, Rothe C, Cadar D, Van Esbroeck M, Foque N, Muñoz J. Causes of fever in returning travelers: a European multicenter prospective cohort study. J Travel Med 2022; 29:6510556. [PMID: 35040473 DOI: 10.1093/jtm/taac002] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Etiological diagnosis of febrile illnesses in returning travelers is a great challenge, particularly when presenting with no focal symptoms [acute undifferentiated febrile illnesses (AUFI)], but is crucial to guide clinical decisions and public health policies. In this study, we describe the frequencies and predictors of the main causes of fever in travelers. METHODS Prospective European multicenter cohort study of febrile international travelers (November 2017-November 2019). A predefined diagnostic algorithm was used ensuring a systematic evaluation of all participants. After ruling out malaria, PCRs and serologies for dengue, chikungunya and Zika viruses were performed in all patients presenting with AUFI ≤ 14 days after return. Clinical suspicion guided further microbiological investigations. RESULTS Among 765 enrolled participants, 310/765 (40.5%) had a clear source of infection (mainly traveler's diarrhea or respiratory infections), and 455/765 (59.5%) were categorized as AUFI. AUFI presented longer duration of fever (p < 0.001), higher hospitalization (p < 0.001) and ICU admission rates (p < 0.001). Among travelers with AUFI, 132/455 (29.0%) had viral infections, including 108 arboviruses, 96/455 (21.1%) malaria and 82/455 (18.0%) bacterial infections. The majority of arboviral cases (80/108, 74.1%) was diagnosed between May and November. Dengue was the most frequent arbovirosis (92/108, 85.2%). After 1 month of follow-up, 136/455 (29.9%) patients with AUFI remained undiagnosed using standard diagnostic methods. No relevant differences in laboratory presentation were observed between undiagnosed and bacterial AUFI. CONCLUSIONS Over 40% of returning travelers with AUFI were diagnosed with malaria or dengue, infections that can be easily diagnosed by rapid diagnostic tests. Arboviruses were the most common cause of AUFI (above malaria) and most cases were diagnosed during Aedes spp. high season. This is particularly relevant for those areas at risk of introduction of these pathogens. Empirical antibiotic regimens including doxycycline or azithromycin should be considered in patients with AUFI, after ruling out malaria and arboviruses.
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Affiliation(s)
| | - Ludovico Cobuccio
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | - Blaise Genton
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Valérie d'Acremont
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | | | | | | | - Carme Subirà
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Isabel Vera
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jara Llenas-Garcia
- Internal Medicine - Infectious Diseases, Vega Baja Hospital, Orihuela, Alicante, Spain.,Clinical Medicine Department, University Miguel Hernández, Elche, Alicante, Spain
| | - Camilla Rothe
- Division of Infectious Diseases and Tropical Medicine, University Hospital LMU, Munich, Germany
| | - Dániel Cadar
- Bernhard Nocht Institute for Tropical Medicine, National Reference Centre for Tropical Pathogens, Hamburg, Germany
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nikki Foque
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jose Muñoz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Runge M, Thawer SG, Molteni F, Chacky F, Mkude S, Mandike R, Snow RW, Lengeler C, Mohamed A, Pothin E. Sub-national tailoring of malaria interventions in Mainland Tanzania: simulation of the impact of strata-specific intervention combinations using modelling. Malar J 2022; 21:92. [PMID: 35300707 PMCID: PMC8929286 DOI: 10.1186/s12936-022-04099-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background To accelerate progress against malaria in high burden countries, a strategic reorientation of resources at the sub-national level is needed. This paper describes how mathematical modelling was used in mainland Tanzania to support the strategic revision that followed the mid-term review of the 2015–2020 national malaria strategic plan (NMSP) and the epidemiological risk stratification at the council level in 2018. Methods Intervention mixes, selected by the National Malaria Control Programme, were simulated for each malaria risk strata per council. Intervention mixes included combinations of insecticide-treated bed nets (ITN), indoor residual spraying, larval source management, and intermittent preventive therapies for school children (IPTsc). Effective case management was either based on estimates from the malaria indicator survey in 2016 or set to a hypothetical target of 85%. A previously calibrated mathematical model in OpenMalaria was used to compare intervention impact predictions for prevalence and incidence between 2016 and 2020, or 2022. Results For each malaria risk stratum four to ten intervention mixes were explored. In the low-risk and urban strata, the scenario without a ITN mass campaign in 2019, predicted high increase in prevalence by 2020 and 2022, while in the very-low strata the target prevalence of less than 1% was maintained at low pre-intervention transmission intensity and high case management. In the moderate and high strata, IPTsc in addition to existing vector control was predicted to reduce the incidence by an additional 15% and prevalence by 22%. In the high-risk strata, all interventions together reached a maximum reduction of 76%, with around 70% of that reduction attributable to high case management and ITNs. Overall, the simulated revised NMSP was predicted to achieve a slightly lower prevalence in 2020 compared to the 2015–2020 NMSP (5.3% vs 6.3%). Conclusion Modelling supported the choice of intervention per malaria risk strata by providing impact comparisons of various alternative intervention mixes to address specific questions relevant to the country. The use of a council-calibrated model, that reproduces local malaria trends, represents a useful tool for compiling available evidence into a single analytical platform, that complement other evidence, to aid national programmes with decision-making processes. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-022-04099-5.
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Affiliation(s)
- Manuela Runge
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland.
| | - Sumaiyya G Thawer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Fabrizio Molteni
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Frank Chacky
- National Malaria Control Programme, Dodoma, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Sigsbert Mkude
- National Malaria Control Programme, Dodoma, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Renata Mandike
- National Malaria Control Programme, Dodoma, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Robert W Snow
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.,Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Ally Mohamed
- National Malaria Control Programme, Dodoma, Tanzania.,Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Basel, Switzerland. .,University of Basel, Basel, Switzerland. .,CHAI, Clinton Health Access Initiative, New York, USA.
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45
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Alaran AJ, Badmos AO, Bouaddi O, Adebisi YA, Ben-Umeh K, Idris U, Lucero-Prisno DE. Decisive or impulsive? Re-examining Africa's lockdown response to COVID-19. Trop Med Health 2022; 50:22. [PMID: 35260200 PMCID: PMC8902732 DOI: 10.1186/s41182-022-00414-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 02/28/2022] [Indexed: 11/18/2022] Open
Abstract
Due to the high transmission rate and mortality index of the current coronavirus pandemic, many settings in Africa instituted lockdowns to reduce its rate of spread and avert exponential growth rate. At the early stage, this measure seemed to heighten awareness of the virus and subsequently minimized exponential growth of cases. However, these lockdowns have had great consequences on the weak health systems and frail economy in place in many African countries. In this paper, we examine the impact of lockdown measures in these countries and provides key recommendations in dealing with present and future pandemics.
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Affiliation(s)
| | | | | | | | | | - Umarfarouq Idris
- National Agency for Food and Drug Administration and Control, Abuja, Nigeria
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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46
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Hakizimana D, Ntizimira C, Mbituyumuremyi A, Hakizimana E, Mahmoud H, Birindabagabo P, Musanabaganwa C, Gashumba D. The impact of Covid-19 on malaria services in three high endemic districts in Rwanda: a mixed-method study. Malar J 2022; 21:48. [PMID: 35164781 PMCID: PMC8845295 DOI: 10.1186/s12936-022-04071-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Rwanda has achieved impressive reductions in malaria morbidity and mortality over the past two decades. However, the disruption of essential services due to the current Covid-19 pandemic can lead to a reversal of these gains in malaria control unless targeted, evidence-based interventions are implemented to mitigate the impact of the pandemic. The extent to which malaria services have been disrupted has not been fully characterized. This study was conducted to assess the impact of Covid-19 on malaria services in Rwanda. Methods A mixed-methods study was conducted in three purposively selected districts in Rwanda. The quantitative data included malaria aggregated data reported at the health facility level and the community level. The data included the number of malaria tests, uncomplicated malaria cases, severe malaria cases, and malaria deaths. The qualitative data were collected using focus group discussions with community members and community health workers, as well as in-depth interviews with health care providers and staff working in the malaria programme. Interrupted time series analysis was conducted to compare changes in malaria presentations between the pre-Covid-19 period (January 2019 to February 2020) and Covid-19 period (from March 2020 to November 2020). The constant comparative method was used in qualitative thematic analysis. Results Compared to the pre-Covid-19 period, there was a monthly reduction in patients tested in health facilities of 4.32 per 1000 population and a monthly increase in patients tested in the community of 2.38 per 1000 population during the Covid-19 period. There was no change in the overall presentation rate for uncomplicated malaria. The was a monthly reduction in the proportion of severe malaria of 5.47 per 100,000 malaria cases. Additionally, although healthcare providers continued to provide malaria services, they were fearful that this would expose them and their families to Covid-19. Covid-19 mitigation measures limited the availability of transportation options for the community to seek care in health facilities and delayed the implementation of some key malaria interventions. The focus on Covid-19-related communication also reduced the amount of health information for other diseases provided to community members. Conclusion The Covid-19 pandemic resulted in patients increasingly seeking care in the community and poses challenges to maintaining delivery of malaria services in Rwanda. Interventions to mitigate these challenges should focus on strengthening programming for the community and home-based care models and integrating malaria messages into Covid-19-related communication. Additionally, implementation of the interrupted interventions should be timed and overlap with the malaria transmission season to mitigate Covid-19 consequences on malaria.
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47
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Wahl I, Wardemann H. How to induce protective humoral immunity against Plasmodium falciparum circumsporozoite protein. J Exp Med 2022; 219:212951. [PMID: 35006242 PMCID: PMC8754000 DOI: 10.1084/jem.20201313] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
The induction of protective humoral immune responses against sporozoite surface proteins of the human parasite Plasmodium falciparum (Pf) is a prime goal in the development of a preerythrocytic malaria vaccine. The most promising antibody target is circumsporozoite protein (CSP). Although PfCSP induces strong humoral immune responses upon vaccination, vaccine efficacy is overall limited and not durable. Here, we review recent efforts to gain a better molecular and cellular understanding of anti-PfCSP B cell responses in humans and discuss ways to overcome limitations in the induction of stable titers of high-affinity antibodies that might help to increase vaccine efficacy and promote long-lived protection.
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Affiliation(s)
- Ilka Wahl
- B Cell Immunology, German Cancer Research Center, Heidelberg, Germany
| | - Hedda Wardemann
- B Cell Immunology, German Cancer Research Center, Heidelberg, Germany
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48
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Irabuena C, Scarone L, de Souza GE, Aguiar ACC, Mendes GR, Guido RVC, Serra G. Synthesis and antiplasmodial assessment of nitazoxanide and analogs as new antimalarial candidates. Med Chem Res 2022; 31:426-435. [PMID: 35106047 PMCID: PMC8794615 DOI: 10.1007/s00044-021-02843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/16/2021] [Indexed: 10/26/2022]
Abstract
During the last years, the progression to control malaria disease seems to be slowed and WHO (World Health Organization) reported a modeling analysis with the prediction of the increase in malaria morbidity and mortality in sub-Saharan Africa during the COVID-19 pandemic. A rapid way to the discovery of new drugs could be carried out by performing investigations to identify drugs based on repurposing of "old" drugs. The 5-nitrothiazole drug, Nitazoxanide was shown to be active against intestinal protozoa, human helminths, anaerobic bacteria, viruses, etc. In this work, Nitazoxanide and analogs were prepared using two methodologies and evaluated against P. falciparum 3D7. A bithiazole analog, showed attractive inhibitory activity with an EC50 value of 5.9 μM, low propensity to show toxic effect against HepG2 cells at 25 μM, and no cross-resistance with standard antimalarials.
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Affiliation(s)
- Camila Irabuena
- Química Farmacéutica, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, General Flores 2124, CC1157 Montevideo, Uruguay
- Graduate Program in Chemistry, Facultad de Química, Universidad de la República, Montevideo, Uruguay
| | - Laura Scarone
- Química Farmacéutica, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, General Flores 2124, CC1157 Montevideo, Uruguay
| | - Guilherme Eduardo de Souza
- São Carlos Institute of Physics, University of Sao Paulo, Avenida João Dagnone, 1100, São Carlos, São Paulo 13563-120 Brazil
| | - Anna Caroline Campos Aguiar
- São Carlos Institute of Physics, University of Sao Paulo, Avenida João Dagnone, 1100, São Carlos, São Paulo 13563-120 Brazil
| | - Giovana Rossi Mendes
- São Carlos Institute of Physics, University of Sao Paulo, Avenida João Dagnone, 1100, São Carlos, São Paulo 13563-120 Brazil
| | - Rafael Victorio Carvalho Guido
- São Carlos Institute of Physics, University of Sao Paulo, Avenida João Dagnone, 1100, São Carlos, São Paulo 13563-120 Brazil
| | - Gloria Serra
- Química Farmacéutica, Departamento de Química Orgánica, Facultad de Química, Universidad de la República, General Flores 2124, CC1157 Montevideo, Uruguay
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49
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Yaro JB, Tiono AB, Ouedraogo A, Lambert B, Ouedraogo ZA, Diarra A, Traore A, Lankouande M, Soulama I, Sanou A, Worrall E, Agboraw E, Sagnon N, Ranson H, Churcher TS, Lindsay SW, Wilson AL. Risk of Plasmodium falciparum infection in south-west Burkina Faso: potential impact of expanding eligibility for seasonal malaria chemoprevention. Sci Rep 2022; 12:1402. [PMID: 35082312 PMCID: PMC8791962 DOI: 10.1038/s41598-022-05056-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
Burkina Faso has one of the highest malaria burdens in sub-Saharan Africa despite the mass deployment of insecticide-treated nets (ITNs) and use of seasonal malaria chemoprevention (SMC) in children aged up to 5 years. Identification of risk factors for Plasmodium falciparum infection in rural Burkina Faso could help to identify and target malaria control measures. A cross-sectional survey of 1,199 children and adults was conducted during the peak malaria transmission season in the Cascades Region of south-west Burkina Faso in 2017. Logistic regression was used to identify risk factors for microscopically confirmed P. falciparum infection. A malaria transmission dynamic model was used to determine the impact on malaria cases averted of administering SMC to children aged 5-15 year old. P. falciparum prevalence was 32.8% in the study population. Children aged 5 to < 10 years old were at 3.74 times the odds (95% CI = 2.68-5.22, P < 0.001) and children aged 10 to 15 years old at 3.14 times the odds (95% CI = 1.20-8.21, P = 0.02) of P. falciparum infection compared to children aged less than 5 years old. Administration of SMC to children aged up to 10 years is predicted to avert an additional 57 malaria cases per 1000 population per year (9.4% reduction) and administration to children aged up to 15 years would avert an additional 89 malaria cases per 1000 population per year (14.6% reduction) in the Cascades Region, assuming current coverage of pyrethroid-piperonyl butoxide ITNs. Malaria infections were high in all age strata, although highest in children aged 5 to 15 years, despite roll out of core malaria control interventions. Given the burden of infection in school-age children, extension of the eligibility criteria for SMC could help reduce the burden of malaria in Burkina Faso and other countries in the region.
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Affiliation(s)
- Jean Baptiste Yaro
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Department of Biosciences, Durham University, Durham, UK
| | - Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Alphonse Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Ben Lambert
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Z Amidou Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Amidou Diarra
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Adama Traore
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Malik Lankouande
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Issiaka Soulama
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso
| | - Antoine Sanou
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
- Institute of Biodiversity, Animal Health & Comparative Medicine, Glasgow University, Glasgow, UK
| | - Eve Worrall
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Efundem Agboraw
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - N'Fale Sagnon
- Centre National de Recherche et de Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - Hilary Ranson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Thomas S Churcher
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | | | - Anne L Wilson
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK.
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50
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Musa SS, Wang X, Zhao S, Li S, Hussaini N, Wang W, He D. The Heterogeneous Severity of COVID-19 in African Countries: A Modeling Approach. Bull Math Biol 2022; 84:32. [PMID: 35067773 PMCID: PMC8784278 DOI: 10.1007/s11538-022-00992-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/01/2022] [Indexed: 02/06/2023]
Abstract
The COVID-19 pandemic has had a considerable impact on global health and economics. The impact in African countries has not been investigated thoroughly via fitting epidemic models to the reported COVID-19 deaths. We downloaded the data for the 12 most-affected countries with the highest cumulative COVID-19 deaths to estimate the time-varying basic reproductive number ([Formula: see text]) and infection attack rate. We develop a simple epidemic model and fitted it to reported COVID-19 deaths in 12 African countries using iterated filtering and allowing a flexible transmission rate. We observe high heterogeneity in the case-fatality rate across the countries, which may be due to different reporting or testing efforts. South Africa, Tunisia, and Libya were most affected, exhibiting a relatively higher [Formula: see text] and infection attack rate. Thus, to effectively control the spread of COVID-19 epidemics in Africa, there is a need to consider other mitigation strategies (such as improvements in socioeconomic well-being, healthcare systems, the water supply, and awareness campaigns).
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Affiliation(s)
- Salihu Sabiu Musa
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China
- Department of Mathematics, Kano University of Science and Technology, Wudil, Nigeria
| | - Xueying Wang
- Department of Mathematics and Statistics, Washington State University, Pullman, WA USA
| | - Shi Zhao
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
- Shenzhen Research Institute of Chinese University of Hong Kong, Shenzhen, China
| | - Shudong Li
- Cyberspace Institute of Advanced Technology, Guangzhou University, Guangzhou, 510006 China
| | - Nafiu Hussaini
- Department of Mathematical Sciences, Bayero University Kano, Kano, Nigeria
| | - Weiming Wang
- School of Mathematics and Statistics, Huaiyin Normal University, Huaian, 223300 China
| | - Daihai He
- Department of Applied Mathematics, Hong Kong Polytechnic University, Hong Kong, China
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